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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Costs and benefits

Amounts change every year

Figures on this page are for 2026 and were checked on 6 October 2026. Medicare announces new amounts each autumn; this page is reviewed every November.

In short

In the US, people of any age whose kidneys have failed, and who need regular dialysis or have had a transplant, can usually get Medicare, if they (or a spouse or parent) have worked long enough under Social Security, the Railroad Retirement Board or as a government employee. Medicare calls this ESRD (end-stage renal disease), its legal name for kidney failure (Medicare). It usually starts in the fourth month of dialysis, and it ends 36 months after a transplant, so plan ahead for anti-rejection medicine costs. Your dialysis or transplant social worker is the best person to help you through this. Outside the US, dialysis and transplant are usually covered by the national health system.

Your numbers (US, 2026)

What 2026 amount Source
Part B monthly premium (standard) $202.90 CMS
Part B yearly deductible $283 CMS
Part A hospital deductible (per benefit period) $1,736 CMS
Immunosuppressive drug benefit (Part B-ID) premium $121.60 a month (more with higher income) Medicare; CMS
Part B-ID yearly deductible $283, then you pay 20 % of the Medicare-approved amount Medicare
Insulin covered by Part B or Part D No more than $35 for each month's supply of each covered insulin; no deductible Medicare
Kidney disease education (stage 4) Up to 6 sessions; 20 % coinsurance after the Part B deductible; needs a doctor's referral Medicare
Extra Help with drug costs No more than $12.65 for each covered drug Medicare
Advance care planning $0 when part of your "Welcome to Medicare" or yearly Wellness visit (provider accepts assignment); otherwise the Part B deductible and 20 % apply Medicare

Medicare for kidney failure: when it starts and ends

Situation Medicare usually starts Source
In-center dialysis The first day of the fourth month of dialysis Medicare
Home dialysis training at a Medicare-certified facility during the first 3 months As early as the first month of dialysis, if your doctor expects you to finish training and do your own treatments, and you keep up regular dialysis Medicare
Kidney transplant The month you are admitted to a Medicare-certified hospital for the transplant (if it happens that month or within 2 months); if the transplant is delayed, 2 months before it Medicare
Situation Medicare based on kidney failure ends Source
You stop dialysis (kidneys recover) 12 months after the month you stop Medicare
You have a kidney transplant 36 months after the month of the transplant Medicare

Other rules worth knowing (Medicare):

  • Employer health plans: if you have a job-based plan, it pays first and Medicare pays second for a 30-month coordination period.
  • Medicare Advantage: people with ESRD can choose Original Medicare or a Medicare Advantage plan.
  • After a transplant: the Part B immunosuppressive drug benefit (Part B-ID) helps pay for anti-rejection medicines once your ESRD Medicare ends. You can get it if you had Medicare because of kidney failure when you had the transplant, and you do not have other cover for these medicines (such as a group or individual health plan, TRICARE or Medicaid). It covers only these medicines. You can sign up at any time by calling Social Security at 1-877-465-0355.
  • Signing up is your choice, but timing matters. Talk it through with your social worker before you decide.
  • Travel abroad: Original Medicare usually does not pay for care outside the US, and Medicare drug plans do not cover medicines bought abroad (Medicare; Travel).

Other help with costs (US)

  • Medicaid and Medicare Savings Programs: run by your state. They can pay Medicare premiums, and sometimes deductibles and coinsurance. Apply through your state Medicaid office; apply even if you are not sure you qualify (Medicare).
  • American Kidney Fund HIPP grants: help with health insurance premiums for people on dialysis with household income up to 500 % of the federal poverty level and limited savings. Covers premiums for Medicare Part B, Medigap, Medicare Advantage, employer, COBRA and other plans. Apply with your dialysis social worker (AKF).
  • Social Security disability: SSDI depends on your work record; SSI is for people with limited income and savings (SSA). Dialysis expected to last at least 12 months meets Social Security's kidney listing, and you are counted as disabled for 1 year after a kidney transplant (SSA Blue Book). See Working.

Outside the US

  • In most countries with a national health system, dialysis, transplant and anti-rejection medicines are covered. Ask your kidney unit's social worker or your national kidney charity what is free, what you pay, and what help exists for travel to dialysis.
  • UK example: Kidney Care UK offers grants to UK residents on a low income at CKD stage 4–5 (including dialysis and conservative care) or with a transplant. Applicants must be over 18, or have an adult or guardian apply for them, and need a letter of support from a health professional (Kidney Care UK).
  • Before traveling abroad, check that your travel insurance covers dialysis, your transplant and your diabetes (Travel).

What to do

  • Meet your dialysis or transplant social worker and ask for a benefits check.
  • If you have an employer plan, ask how it works with Medicare during the 30-month coordination period.
  • Before a transplant, plan how you will pay for anti-rejection medicines after Medicare ends, including the Part B-ID benefit.
  • Check that your insulin is covered under Part B or Part D, so the $35 monthly cap applies.
  • Ask your doctor to refer you for kidney disease education if you have Medicare and stage 4 CKD.
  • Keep copies of every letter from Medicare, Social Security and your insurer.
  • Each November, check this page and medicare.gov for next year's amounts.

Examples

Starting in-center dialysis. You start hemodialysis on 10 March 2026. Medicare usually starts on 1 June 2026, the first day of the fourth month (Medicare).

Starting home dialysis training. You start dialysis on 10 March 2026 and begin home PD training in April. If your doctor expects you to finish training and you keep up your dialysis, Medicare can start in March, the first month of dialysis (Medicare).

After a transplant. You have a transplant in September 2026. Your ESRD Medicare ends 36 months after that month. Before then, your transplant social worker helps you sign up for Part B-ID or another plan, so your anti-rejection medicines stay covered (Medicare).

Insulin costs. You use three different insulins covered by Part D. Each one costs you no more than $35 for a month's supply (Medicare).

Ask your care team (and social worker)

  1. Am I eligible for Medicare because of kidney failure, and when should I sign up?
  2. How does Medicare work with my employer plan or Medicaid?
  3. Can you help me apply for a HIPP grant, Medicaid or a Medicare Savings Program?
  4. After a transplant, how will I pay for anti-rejection medicines when my Medicare ends?
  5. Can you help me apply for disability benefits?

Get help now if…

Never skip insulin because of cost

Running out of insulin with type 1 diabetes can lead to DKA, a dangerous build-up of ketones (ADA). If you cannot afford insulin or other medicines, call your diabetes team or pharmacist today. If you have ketones of 3.0 mmol/L or more, or any ketones with vomiting so you cannot keep fluids down, call 911. Full list: Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06. Prices and benefit amounts as of 2026-10-06.