May 09 2010
What Dialysis Costs are Covered by Medicare?
Part B medical insurance helps pay for outpatient maintenance dialysis treatments in any approved dialysis facility, including the costs of laboratory tests, supplies, equipment, and other services associated with treatment. Charges for maintenance dialysis vary from one approved facility to another. Medicare pays the facility based on a per treatment rate that is set in advance. This rate is known as the composite rate. Medicare pays 80% of the composite rate minus any part of the Part B deductible they have yet to meet. You are responsible for any unmet Part B deductible plus the remaining 20% of the composite rate. The facility may never charge more than the unmet Part B deductible plus 20% of its Medicare composite rate.
Physicians’ services also are covered while you are receiving dialysis treatment. Medicare pays for these services via a monthly capitation payment. The amount is paid regardless of whether a patient dialyzes as an outpatient in a dialysis facility, or at home. Under this method, Medicare pays 80% of a physician’s monthly payment less any unmet Part B deductible. A patient pays any unmet Part B deductible plus the remaining 20% of the monthly payment. If a physician accepts assignment, Medicare will pay them directly, and you may not be charged more than the unmet Part B deductible plus 20% of the monthly capitation payment. (Assignment means that a doctor accepts the payment approved by Medicare as the total payment). If a physician does not accept assignment, you receive the payment and there is no limit on the amount that can be charged.
If you’re admitted to a hospital because you medical condition requires the availability of other specialized hospital services on an inpatient basis, the maintenance dialysis treatments would be covered by hospital insurance (Part A), as part of the costs of the covered inpatient hospital stay. While you are hospitalized, a physician may elect to be paid for each individual service that they provide. In such a case, a physician receives a prorated portion of the monthly capitation payment, reduced in proportion to the total number of days that you are hospitalized.
Medicare and Self-Care Dialysis
If people participate in a self-care training program within the first three months after treatment has begun with the intention of doing self-care (aka “home”) dialysis, Medicare benefits will start during the month that the self-care training begins.