Medicare paying for home dialysis


#1

Hello. My sister lives in Charleston County SC. She has end stage renal disease. She has full Medicare coverage. She has been going to a dialysis center for 2 years. She wants to have dialysis at home. She needs a health care worker. Will Medicare pay for the health care worker as well as the supplies. She lives by herself and is living on Disability payments. Thank you for any info.-Virginia


#2

Medicare does not cover the cost of a helper for dialysis. Other types of insurance that offer private duty nursing may cover the cost of a helper for those patients who have no one to help them and don’t have the funds to pay privately.

Many patients who do dialysis at home have family members or friends who help with dialysis after they and the patient have been trained. Although most dialysis clinics require patients to have a helper for home hemodialysis, some do not if the patient can prove after completing training that he/she is competent to perform the entire treatment independently, recognizes and will report symptoms/problems that may occur, and has a way to summon help quickly if needed.

There are other options for treatment besides in-center dialysis. Most patients who are trained to do either of the types of peritoneal dialysis (manual or with a machine) can do it independently without a helper.

Dialysis clinics must be certified by Medicare to provide home training and support. Some clinics are not certified to provide home training and support. The dialysis clinic should make sure that your sister is aware of all options for treatment and that she knows where she can get other treatments not provided by her clinic. From the home page of this website, you can find information about options for treatment, what clinics are certified to provide different types of home dialysis in her area, and more. You can also read about options for treatment on Kidney School (www.kidneyschool.org).


#3

I have another question about Medicare paying for home hemodialysis. Is it still the case that Medicare only pays for three treatments per week and that you might be able to get coverage for a fourth treatment if your doctor writes a note?


#4

It’s still true that Medicare routinely covers 3 treatments a week. In some cases, Medicare will pay for more treatments if there is medical justification for them. The doctor has to provide the medical justification and send it to the insurance company that pays the Medicare claim. Medical justification may need to be provided to the insurance company that pays Medicare claims with every bill. The facility could contact the fiscal intermediary or Medicare administrative contractor to find out how often justification is required.


#5

i may not be answering what your asking, but are you asking if medicare pays for more than three sessions 'at home"? We do dialysis 5-6 days per week, at home, paid for my medicare. Or were you asking something else…


#6

Do you have Original (traditional) Medicare or a Medicare Advantage plan? Medicare’s manual states that Medicare covers 3 treatments a week. We have heard that some clinics have had success billing some of the insurance companies that pay Medicare claims – called fiscal intermediaries (FIs) or Medicare administrative contractors (MACs) while others have not. It may be a geographic thing or related to the patient’s condition and how medical justification is provided.