Insurance coverage for dialysis is complex and individualized
This page provides a general overview of how coverage typically works for dialysis patients. For questions about a specific plan or situation, Cooper's social worker is part of every patient's care team and can help work through the details.
Overview
How Dialysis is Typically Covered
Most people receiving dialysis are covered under one of four types of insurance: Medicare, Medicare Advantage, commercial or employer-sponsored insurance, or Medicaid. Many patients have more than one type of coverage at the same time. Understanding how they work together is important.
One of the most important things to know is that ESRD (end-stage kidney disease) qualifies a patient for Medicare regardless of age. Most people think of Medicare as being for those 65 and older, but kidney failure is one of the few conditions that opens Medicare eligibility to younger patients as well.
Medicare
Primary coverage for most dialysis patients
Cooper accepts Medicare. Medicare is the primary payer for the majority of dialysis patients in the United States.
Medicare Part A & Part B
Original Medicare—the foundation of ESRD coverage. Most dialysis patients use both Part A (hospital insurance) and Part B (medical insurance). For home dialysis patients specifically, Part B covers the core of ongoing care:
Home dialysis treatments — both PD and HHD
Dialysis equipment and supplies delivered to the home
Home dialysis training for the patient and a care helper
Most ESRD-related medications and lab work
Outpatient physician services related to kidney disease
Part A covers inpatient hospital dialysis when a hospital stay is required.
Home dialysis patients may qualify for Medicare sooner
For patients who begin in-center hemodialysis, Medicare typically does not become active until 90 days after dialysis starts. For patients who choose peritoneal dialysis or home hemodialysis, Medicare coverage can begin immediately upon the start of dialysis — potentially covering costs from the very first treatment. This is a meaningful financial advantage for patients who are choosing their modality before starting treatment.
Medicare covers 80% of approved dialysis costs after the Part B deductible. Patients are typically responsible for the remaining 20% — which is where supplemental coverage (Medigap) or secondary insurance can help reduce out-of-pocket costs.
Additional
Coverage Types
Other Coverage Options
Medicare Advantage (Part C)
An alternative to Original Medicare through private insurers.
Medicare Advantage plans are required to cover at least the same dialysis services as Original Medicare, but plan rules, networks, and costs vary significantly. Patients on Medicare Advantage should verify that their specific plan covers home dialysis and that Cooper is in network before starting treatment.
Commercial & Employer
Employer-sponsored or individually purchased plans.
Many patients have employer-sponsored or commercial health insurance at the time they start dialysis. Under Medicare's Secondary Payer (MSP) rules, employer insurance typically remains the primary payer for the first 30 months of ESRD eligibility — Medicare becomes the primary payer after that period.
Coverage specifics vary significantly by plan. Contact Cooper's team directly to discuss whether your specific commercial plan is accepted.
Cooper's
Support
Your Cooper Social Worker is Part of your Care Team
Insurance navigation is one of the most important things a dialysis social worker does at Cooper.
Every patient has a dedicated social worker as part of their care team from the start. Insurance questions don't have to be figured out alone.
What Cooper's social worker can help with
Your social worker can help with understanding what your current plan covers, navigating Medicare enrollment, identifying supplemental coverage options, connecting you with financial assistance programs like the American Kidney Fund's HIPP grant, and coordinating with Cooper's billing team on coverage questions.
Still unsure if home dialysis is right for you?
