Key takeaways:
Dialysis — a method of cleaning your blood — is necessary if your kidneys fail.
Without insurance, a dialysis treatment can cost $500 or more per session. Even if your health insurance covers dialysis, you may have out-of-pocket expenses.
Most people who need dialysis because of end-stage kidney disease can qualify for Medicare regardless of age. There are also government and nonprofit resources that can help with your out-of-pocket costs.
More than 15% of U.S. adults have chronic kidney disease, which inhibits the body's ability to remove waste and extra water. The most severe form of chronic kidney disease is kidney failure.
People with kidney failure depend on dialysis to clean their blood and eliminate waste. Even with health insurance, the costs associated with dialysis can add up.
What is dialysis?
Dialysis is a method of removing waste, salt, and fluid from the body. It is used for people whose kidneys can no longer provide that function. Dialysis also helps to control blood pressure and regulates the levels of sodium, potassium, bicarbonate, and other minerals in your blood.
There are two types of dialysis:
Hemodialysis uses an "artificial kidney" called a dialyzer to remove waste and filter your blood outside of your body.
Peritoneal dialysis uses the lining of your abdomen to filter your blood inside of your body.
Hemodialysis is typically performed in a dialysis center, while peritoneal dialysis is often conducted at home.
When is dialysis necessary?
Dialysis is needed if you experience kidney failure, which is also called end-stage renal disease (ESRD) or end-stage kidney disease. Kidney failure is typically diagnosed when less than 15% of the organ is working normally.
In most cases, kidney failure is permanent, and dialysis becomes necessary for the rest of your life unless you get a kidney transplant. However, if kidney failure is temporary, dialysis may only be necessary until the kidneys start functioning properly again.
How much does dialysis cost?
The costs associated with kidney failure can be staggering. In fact, commercial insurance plans spent $14,399 per month on all healthcare services in 2016 for a person with ESRD — 33 times the costs for a person without kidney failure ($435 per month), according to a JAMA Internal Medicine analysis. Commercial insurance plans spent an average of $10,149 per month per enrollee for outpatient dialysis alone, the study found.
Because dialysis is a required treatment scheduled several times a week and includes a team of providers, the cost is often bundled with other expenses related to managing your condition.
Hemodialysis typically costs more than peritoneal dialysis. In 2017, Medicare’s average annual expenses were $108,656 per person for hemodialysis and $91,716 per person for peritoneal dialysis.
An analysis published in 2022 of nearly 2 million employer-sponsored health plan claims from 2012 to 2109 found that private insurers paid $1,287, on average, for a hemodialysis session. For comparison, the highest Medicare base rate for the service during that time was $240.
If you don't have insurance, your costs will be even higher. For instance, one hemodialysis treatment can cost $500 or more. If you go three times a week, that's at least $1,500 per week, $6,000 per month, and $72,000 per year. The costs for your entire care may be much more, however, because a single self-pay dialysis treatment usually would not include the costs associated with your medical team.
Your cost for hemodialysis will depend on several factors, including:
Where you receive treatment (major dialysis center, hospital-based, etc.)
Where you live (a 2022 study found that the average price ranged from $950 in Arkansas to $1,791 in West Virginia)
If you are insured, the negotiated price by your health plan
If the treatment is scheduled or an emergency
Your cost-sharing, such as deductibles, copays, and coinsurance
Even if your insurance plan pays for dialysis, there may be other costs to consider. In addition to your deductible, copays, and coinsurance, you may have costs associated with treatment at a dialysis center, such as:
Lost income from time off from work
Transportation to and from appointments
Child care
If you receive your dialysis at home, you may need to pay some or all of the costs for medical equipment.
Any kind of dialysis also may require prescriptions, which may present other out-of-pocket costs.
Does insurance cover dialysis?
Yes. If you have private insurance, Medicare, a Medicare Advantage (MA) plan, or Medicaid, your dialysis typically will be covered with some out-of-pocket costs.
Most people in the U.S. with ESRD who need dialysis can receive Medicare at any age if one of the following applies:
You are eligible for or already receive Social Security or Railroad Retirement Board (RRB) benefits
You have worked long enough under Social Security, the Railroad Retirement Board, or as a government employee
You are the spouse or dependent child of a person who meets either of the above requirements
Medicare coverage has a waiting period that usually begins the first day of the fourth month of your dialysis treatment. For instance, if your dialysis starts July 1, your coverage will begin October 1. Coverage can begin earlier if you start hemodialysis, participate in home dialysis training, and plan to switch to home dialysis.
Original Medicare will cover approximately 80% of the costs of dialysis as well as related supplies and services. Medicare supplement insurance (Medigap) can help with the remaining 20%, which are your out-of-pocket costs.
Half of people in the U.S. with ESRD also qualify for Medicaid, which can operate as supplemental insurance to Medicare and cover out-of-pocket costs. Medicaid coverage may begin during the waiting period before Medicare coverage starts.
Veterans can receive coverage for dialysis under Veterans Affairs (VA) healthcare benefits. You may qualify for home dialysis coverage or non-VA care in your community. Benefits also may include reimbursement for money spent traveling to and from dialysis.
TRICARE also covers dialysis for service members, retirees, and eligible family members.
Can I get dialysis free?
Possibly, when you consider all options. You may pay nothing or very little if your dialysis is covered by Medicare and other costs are covered by Medicaid or Medigap — though you often pay a monthly premium for Medigap. You may be eligible for financial help for out-of-pocket costs associated with dialysis from nonprofit organizations, state-based assistance programs, and other sources.
In some cases, you may qualify for special programs to help you pay out-of-pocket costs associated with dialysis. The American Kidney Fund has grant programs that provide financial assistance for expenses such as:
Insurance premiums
Copays
Medications
Transportation costs to and from dialysis
The bottom line
Dialysis can be costly even if you have health insurance. Most people in the U.S. with kidney failure will qualify for Medicare regardless of age, and about half of people with dialysis are eligible for Medicaid. Most people will pay copays for treatment and out-of-pocket costs related to medications and transportation. Your dialysis costs can be less if you have treatment at home.
If you need financial help, you may qualify for one of many assistance programs.
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