Dialysis Cost

Typical costs:

• Dialysis is covered by health insurance. For patients covered by health insurance, out-of-pocket costs typically include the deductible, and coinsurance for the treatment cost. For example, with Medicare, a patient, once the deductible of about $150 is met, typically would pay coinsurance of 20%; but many Medicare patients also have secondary insurance to cover all or part of that cost. A study published in Health Affairs[1] showed that the average U.S. patient pays $114 for dialysis-related drug costs and about $10 in dialysis costs per month.
• For patients not covered by health insurance, a single hemodialysis treatment typically costs up to $500 or more -- or, about $72,000 or more per year for the typical three treatments per week. Injectable medications and vitamins can add hundreds of dollars to the cost, depending on what is prescribed. For example, DaVita[2] , which has many dialysis centers across the United States, charges about $480 for a dialysis treatment, not including medications. A dialysis center in Ohio quotes a rate of more than $1,400 but will negotiate with self-pay patients.
• An emergency, unscheduled dialysis treatment at a hospital can cost much more; for example, Baptist Memorial Health Care in Memphis charges about $9,900 for a single treatment. For peritoneal dialysis, the main costs consist of medical supplies to perform the procedure at home -- so it is slightly less expensive than hemodialysis. According to the U.S. Renal Data System, one year of hemodialysis can total $72,000; a year of peritoneal dialysis can cost about $53,000.
• Most patients with end-stage renal disease are eligible for Medicare; however, there typically is a waiting period of up to four months before coverage starts (or, if the patient is insured through an employer group health plan, that plan will be the primary payer for 30 months). Medicare.gov[3] has information on Medicare and end-stage renal disease. Medicare Part B, which is necessary to get dialysis benefits, costs more than $100 per month.

• In continuous peritoneal dialysis, which typically is done several times per day or at night by a machine, a cleansing solution is pumped via a catheter into the abdomen. A membrane in the abdomen draws wastes, excess sodium and fluids into the solution, which is then drained out of the body. The process must be repeated several times per day or continuously at night. In hemodialysis, which typically is done three or more times per week, the patient sits in a reclining chair as the blood is removed and run through a filter in a machine, then returned to the body.
• The National Institutes of Health has overviews of peritoneal dialysis[4] and kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis/>hemodialysis. The American Association of Kidney Patients has an article on home hemodialysis; dialysis provider DaVita offers a primer[5] on dialysis drugs and vitamins.

• Hemodialysis requires surgery to create vascular access, while peritoneal dialysis requires surgery to insert a catheter in the abdomen. According to the U.S. Renal Data System, these costs can range from about $1,000 to $7,500 or more.
• For hemodialysis at home, special plumbing and wiring will need to be added for about $1,250-$2,000, according to the American Association of Kidney Patients. Dialysis patients need to follow a special diet under the guidance of a dietician. The National Kidney and Urologic Diseases Clearinghouse[6] offers a primer on dialysis and diet. Many hospitals have dieticians available; an initial consultation can cost $100-$200.

• Some hospitals and/or states provide free dialysis to uninsured patients who cannot afford it. The National Association of Public Hospitals and Health Systems offers a member directory[7] by zip code.
• State kidney programs often offer help paying for care of kidney patients in need. The National Kidney Foundation[8] has a primer on resources for help paying for dialysis and related costs. And the American Kidney Fund[9] offers grants to help with costs.

• A primary care physician can provide a referral to a nephrologist, a doctor who specializes in diseases and disorders of the kidneys. A nephrologist should be certified by the American Board of Internal Medicine[10] and should have undergone several additional years of intensive training in nephrology and passed an ABIM exam.
• The American Association of Kidney Patients has a list of pros and cons of peritoneal dialysis vs. hemodialysis.
• Medicare.gov[11] has a dialysis center locator.
• Medicare.gov also provides a list of questions to ask at a dialysis center[12] and questions to ask a doctor[13] about dialysis.

1.  content.healthaffairs.org/content/27/1/89.full.pdf+html
2.  www.davita.com/unsupported-browser.cfm
3.  www.medicare.gov/Publications/Pubs/pdf/10128.pdf
4.  kidney.niddk.nih.gov/kudiseases/pubs/peritoneal/
5.  www.davita.com/unsupported-browser.cfmdialysis/treatment/common-drugs-prescribed-f...
6.  kidney.niddk.nih.gov/Kudiseases/pubs/eatright/
7.  isgweb.naph.org/isgweb/membership/memberdirectorysearch.aspx
8.  www.kidney.org/transplantation/transAction/pdf/5_MoreSourcesofFinancialHelp.pdf
9.  www.kidneyfund.org/patient-grants/safety-net-grants/
10.  www.abim.org/online/contact.aspx
11.  www.medicare.gov/dialysisfacilitycompare/(S(nquynfjqclkwdjhdm5lsc1vo))/search.aspx...
12.  www.medicare.gov/dialysisfacilitycompare/(S(1zl4rfffe213eg5eihb0j0tl))/search.aspx...
13.  www.medicare.gov/dialysisfacilitycompare/(S(nngr5m311ng2raiteiqceuve))/search.aspx...

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