Does Medicare Cover Kidney Failure?
This article was updated on: 09/10/2018
The kidneys perform the essential function of removing waste and excess water from the body, according to the National Institutes of Health (NIH). Kidney failure, also called end-stage renal disease (ESRD), is the final stage of chronic kidney disease. When your kidneys fail, it means they have stopped working well enough to support your body’s needs. Medical treatment for kidney failure is essential to sustain life, and funding resources, including Medicare coverage, may be available to help you pay for necessary medical treatment.
Causes of kidney failure
Kidney failure can happen to people of any age, including children. In most cases, kidney failure is caused by other health problems that have done permanent damage to your kidneys over time. If the damage to your kidneys continues to get worse and your kidneys are less and less able to do their job, you have chronic kidney disease. The most common causes of kidney failure in the United States are diabetes and high blood pressure, according to the National Institutes of Health.
Symptoms of kidney failure
Chronic kidney disease usually gets worse slowly, and symptoms may not appear until your kidneys are badly damaged. As your condition approaches kidney failure, you may notice symptoms that are caused by waste and extra fluid building up in your body, notes the National Kidney Foundation.
You may notice one or more of the following symptoms if your kidneys are beginning to fail, according to the National Institutes of Health (NIH). You could also have other symptoms besides these.
- Muscle cramps
- Nausea and vomiting
- Not feeling hungry
- Swelling in your feet and ankles
- Trouble catching your breath
Treatment for kidney failure/end stage renal disease (ESRD)
Treatment for kidney failure may involve dialysis or kidney transplant. You may also need to stay on a special diet that is low in sodium, protein and fluids or take prescription medications to help your body work well. Your doctor can help you decide which treatment or combination of treatments is best for you.
Dialysis is one treatment option of kidney failure. According to the NIH, dialysis is a treatment to filter wastes and water from the blood. Two different methods are used to perform dialysis:
- Hemodialysis: During hemodialysis, your blood passes through a tube into an artificial kidney, or filter. Hemodialysis can be performed at a dialysis center or at home.
- Peritoneal dialysis: During peritoneal dialysis, a special solution (dialysate) passes into your belly though a catheter tube to clean your blood. The solution remains in your abdomen for a period of time and then is removed. This method can be done at home, at work, or while traveling.
While dialysis helps to replace some of the work that your kidneys used to do, it is not the same as having working kidneys. You’ll need to take extra steps to stay healthy. You will want to discuss suitable diet, exercise, and possibly prescription medications with your doctor.
Another treatment option for kidney failure in some situations is a kidney transplant. A kidney transplant replaces your kidney with someone else’s healthy kidney. A kidney transplant may come from a live donor (usually someone you know) or from a deceased donor. The replacement kidney can do the job that your kidneys did when they were healthy.
If your doctor recommends a kidney transplant, he or she will refer you to a transplant center. There, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for a kidney transplant. If you are a good candidate, the next step is to identify a suitable organ donor (typically a family member) or await a kidney from a donor. Your transplant team will notify you when the surgery is scheduled and you will be admitted to the hospital for surgery. If you and your doctor find that a kidney transplant is the right treatment for you, you may still need dialysis while waiting for a matching kidney donor.
If you qualify for Medicare Part A, you can also get Medicare Part B. Enrolling in Part B is your choice, but unless you’re covered under other insurance, you’ll typically need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services. If you are a Medicare beneficiary and enrolled in a Medicare Advantage plan at the time you start dialysis, you may be able to stay enrolled in your plan or you may be able to enroll in a Medicare Special Needs Plan (SNP) if one is available near you; it’s a type of Medicare Advantage plan. Many Medicare Advantage plans don’t cover people with end-stage renal failure (ESRD), but a Medicare SNP might cover you.
Medicare Advantage plans are offered by private insurance companies, approved by Medicare. Medicare Advantage plans must offer at least the same coverage as Original Medicare provides other than hospice care, which is covered under Medicare Part A.
If you are not currently enrolled in Medicare (because you are younger than 65 years old, for example), you may qualify for Original Medicare coverage if your doctor has diagnosed your condition as ESRD or kidney failure and you are starting dialysis or have a kidney transplant. To learn if you qualify for Medicare coverage, contact your local Social Security office or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM. The Social Security office will help you enroll in Medicare if you qualify and you are not already enrolled because of your age or a disability. If you worked for a railroad, contact the Railroad Retirement Board for enrollment information at 1-877-772-5772 (TTY users call 1-312-751-4701) Monday through Friday, 9AM to 3:30PM, to speak to an RRB representative.
If you have Original Medicare, Part A and Part B, Medicare will typically cover certain services and supplies related to treatment of kidney failure when you receive care from health care providers who accept Medicare. Generally Medicare covers hospital care such as inpatient dialysis and hospital admissions under Medicare Part A. Medicare Part B may cover professional services delivered by your doctors or your outpatient dialysis center; the services and supplies required for dialysis (such as laboratory tests and dietitian and social worker assistance at the dialysis center); home dialysis equipment, supplies, and some home dialysis medicines. To learn more about what Medicare covers and what it doesn’t cover for treatment of kidney failure, you may want to read the Centers for Medicare & Medicaid publication, “Medicare Coverage of Kidney Dialysis & Kidney Transplant Services.”
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