Dialysis

The main options are hemodialysis at a dialysis center, hemodialysis at home, peritoneal dialysis (usually done at home), and a kidney transplant. Each one fits differently around health, home life, travel and work. Ask the kidney doctor (nephrologist) to walk through all of them, including any your loved one may not be a good fit for, and why.

A machine filters the blood while the person sits in a chair at a dialysis center, usually about 3 times a week for about 4 hours each time. Center staff handle most of the work, and there is no equipment to keep at home. The trade-offs are a fixed schedule and travel to and from the center several times a week.

Home hemodialysis uses a machine at home, which lets the person set their own treatment schedule. It takes several training sessions, and usually a care partner who also trains and helps with setup, monitoring and cleaning. The home may need changes for the machine and water supply, and the dialysis center can tell you what is required.

Peritoneal dialysis uses the lining of the belly as a filter, with cleansing fluid going in and out through a soft tube. It can be done by hand several times a day, or overnight with a machine called a cycler while the person sleeps. It is done at home or in another clean space, and it means storing supplies and doing treatments every day.

Your loved one and their kidney care team decide together. The choice depends on their other health conditions, whether they have a care partner, their home setup, and what matters most to them day to day. It is fine to ask whether switching types later is possible if the first choice stops working well.

Medicare Part B covers home dialysis training for the patient and a helper, the dialysis machine, water treatment system, and many supplies. It also covers visits from trained workers to check on home dialysis and equipment, help in emergencies, and a monthly visit with the doctor. It does not cover paid dialysis aides, lost pay during training, or lodging.

Yes, at any age, if their kidneys have stopped working and they need regular dialysis or have had a kidney transplant. They must also have enough work history under Social Security, the Railroad Retirement Board or as a government employee, already get those benefits, or be the spouse or dependent child of someone who qualifies. You apply through Social Security at 1-800-772-1213.

For in-center dialysis, coverage usually starts on the first day of the fourth month of dialysis. It can start in the first month if the person trains for home dialysis in a Medicare-certified program during the first 3 months. For a transplant, it can start the month the person is admitted to a Medicare-certified hospital for the transplant, if the surgery happens that month or within the next 2 months.

For outpatient dialysis, your loved one pays 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026, plus monthly premiums. A Medigap policy, Medicaid or other coverage may pay some or all of that 20%. The dialysis center’s social worker can help you look at options.

If your loved one has coverage through an employer or union, that plan pays first and Medicare pays second for a 30-month coordination period. The period usually starts the first month the person could get Medicare because of kidney failure. Tell every provider about all coverage so bills go to the right place.

Yes. People with kidney failure can choose Original Medicare or a Medicare Advantage plan. Before joining a plan, confirm that the dialysis center, the kidney doctor, and any transplant center your loved one uses are in the plan’s network.

For people who have Medicare only because of kidney failure, it ends 12 months after the month they stop dialysis, or 36 months after the month of a kidney transplant. It starts again if they go back on dialysis or get another transplant within those windows. If your loved one is 65 or older or has Medicare for a disability, ask Social Security how this applies to them.

Original Medicare covers ambulance rides between home and the nearest dialysis center only when any other way of traveling could put the person’s health at risk. Regular scheduled non-emergency ambulance trips need a written order from the doctor dated no more than 60 days before the ride. Some Medicare Advantage plans cover other kinds of rides, so ask the plan.

Traditional Medicaid members who have no other way to get to medical care may get rides. Depending on where they live, that may be a UTA transit card, a para-transit voucher, or door-to-door rides through ModivCare (1-855-563-4403), which asks for at least 3 business days’ notice. Some people, including those with only Medicare savings program coverage (QMB, SLMB or QI), are not eligible, and nursing home residents can’t get bus passes.

Start with the social worker at the dialysis center, who usually knows the local options. People with Original Medicare can also ask their ESRD Network, the Medicare-funded group that supports dialysis patients in Utah, who handles transportation in their area. Utah Care Network can help you look for providers at no cost to you.

Yes, within the United States. The home dialysis center can help find Medicare-certified centers along the way and send the needed patient information ahead, so plan early. There may be copayments while traveling, and Medicare generally doesn’t pay for care outside the U.S.

Often, yes, but it depends on what the community can handle. Most residents on dialysis travel to a center for treatment, so ask how rides will work, whether staff can help with diet and fluid limits and medicines, and how they handle someone who comes back tired or unwell. Get the community’s answers in writing before you move in.

Yes. A resident may be driven to a dialysis center, go to a center located in or next to the nursing home, or get home-style dialysis inside the nursing home if the facility offers it. Nursing homes are not required to offer dialysis on site, so ask each facility what it does.

Under CMS guidance, the dialysis provider keeps overall responsibility for the dialysis care and must have a written agreement with the nursing home. Anyone who runs treatments must be trained and checked by the dialysis provider first. The nursing home shares in the care plan, including diet and fluid limits.

Ask whether they currently care for residents on dialysis and which dialysis providers they work with. Ask how transportation is arranged, how meals and fluid limits are handled, who watches the access site, and what happens if a resident feels unwell after treatment. Also ask how billing works between the nursing home and the dialysis provider so you aren’t surprised.

Ask the kidney doctor for a referral to a transplant center for an evaluation. The transplant team decides whether a transplant is a safe option based on overall health and other factors. Even if the answer is not yet, ask what would need to change.

Waiting for a kidney from a deceased donor can take years, because far more people need kidneys than there are donors. With a living donor, surgery can be scheduled when both people are ready. Ask the transplant center about living donation and how the waiting list works.

Medicare covers kidney transplants at Medicare-certified hospitals. Part A covers the living donor’s full hospital care before, during and after surgery, and the donor pays no deductible or coinsurance for that stay. The person getting the kidney pays 20% for Part B services after the deductible.

If Medicare helped pay for the transplant, Part B covers anti-rejection drugs. After kidney-failure Medicare ends, people without other coverage for these drugs can sign up for a separate benefit that covers only immunosuppressive drugs, with a 2026 premium of $121.60 a month (higher for some incomes), a $283 deductible, and 20% coinsurance. Medicare lists 1-877-465-0355 for enrolling.

Start by talking with the center’s staff or manager, since many problems can be fixed there. If that doesn’t work, contact the ESRD Network for Utah, run by Comagine Health as ESRD Network 15, which looks into grievances and advocates for patients. Medicare (1-800-MEDICARE) can give you the Network’s phone number.

The dialysis center’s social worker and dietitian are part of your loved one’s care team and are there to answer questions. The National Kidney Foundation runs a free help line, NKF Cares, where patients, family members and care partners can talk with a trained specialist about kidney disease, dialysis or transplant. Your ESRD Network also offers educational materials for patients and families.