What you'll learn
- If you have permanent kidney failure (ESRD) and need regular dialysis or a transplant, you can qualify for Medicare at any age, as long as you or a family member has enough work history.
- For most people on dialysis, Medicare starts the first day of the fourth month of treatment. Home dialysis training can move that start up to the first month.
- Part B covers outpatient and home dialysis. You generally pay 20% of the Medicare-approved amount after the Part B deductible.
- Texas' Kidney Health Care program can help eligible Texans with ESRD pay for dialysis, drugs, travel to treatment, and Medicare premiums.
Most people get Medicare at 65. Kidney failure is different. If your kidneys stop working and you need regular dialysis or a kidney transplant, you may be able to get Medicare at any age. That matters in a state as big as Texas, where many people on dialysis are still working, raising families, or driving a long way to treatment three times a week.
Medicare calls permanent kidney failure End-Stage Renal Disease (ESRD). Here's how coverage works.
Who qualifies
Medicare says you can get Medicare because of ESRD, no matter how old you are, if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of these is true:
- You've worked long enough under Social Security, the Railroad Retirement Board, or as a government employee
- You already get, or are eligible for, Social Security or Railroad Retirement benefits
- You're the spouse or dependent child of someone who meets one of those rules
You sign up through Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or your local office. Medicare says that if you're approved because of ESRD, you can sign up for Part B without a late enrollment penalty. If you already pay a Part B late enrollment penalty, signing up again based on ESRD can stop it.
When coverage starts
This is the part that surprises people. For most people on dialysis, Medicare starts on the first day of the fourth month of treatment. That waiting period starts whether or not you've signed up yet.
It can start sooner. If you take part in a home dialysis training program at a Medicare-certified facility during your first three months and are expected to do your own treatments at home, coverage can begin in the first month of dialysis. For a kidney transplant, coverage can begin the month you're admitted to a Medicare-certified hospital, if the transplant happens that month or within the next two months.
If you sign up late, Medicare coverage based on ESRD can go back up to 12 months before the month you apply. Our guide to Medicare under 65 with a disability in Texas compares this with other early paths into Medicare.
What Part A and Part B pay
Medicare says you need both Part A and Part B to get the full benefits for ESRD under Original Medicare.
| Part | What it helps cover |
|---|---|
| Part A | Dialysis when you're an inpatient in a hospital |
| Part B | Outpatient dialysis at a certified facility or at home, home dialysis training, home equipment and supplies, many dialysis-related drugs, lab tests, and monthly visits with your kidney doctor |
For dialysis in a facility, you generally pay 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026. You also keep paying your monthly Part B premium. There's no yearly cap on that 20% under Original Medicare, and with three treatments a week it can add up fast. Our Part B explainer covers how people fill that gap.
Medicare doesn't cover paid aides for home dialysis, lost pay during training, or a place to stay during treatment. For rides, Part B covers an ambulance to the nearest dialysis facility only when other transportation could endanger your health. See does Medicare cover ambulance rides for details.
If you have insurance through work
If you qualify for Medicare only because of kidney failure and you have an employer or union plan, that plan pays first for a 30-month coordination period. Medicare pays second. After 30 months, Medicare pays first. Tell your dialysis center about all your coverage so claims go to the right place.
Original Medicare or Medicare Advantage?
People with ESRD can choose either one. With Original Medicare, you can use any dialysis facility or doctor that takes Medicare, anywhere in the U.S. That can matter if you travel or might need a transplant center in another city. Some people add a Medicare Supplement (Medigap) policy to help with the 20%, though options and prices can be different if you're under 65.
A Medicare Advantage plan bundles Parts A and B and usually drug coverage, with a yearly out-of-pocket limit. Most use networks, so Medicare suggests checking that your dialysis facility, kidney doctor, and possible transplant specialist are in the plan. Our guide to Medicare Advantage vs. Original Medicare in Texas walks through the trade-offs.
Extra help in Texas
To qualify, Texas HHS says you must live in Texas, have income under $60,000 a year, have an ESRD diagnosis and get regular dialysis or have had a transplant, and not be eligible for Medicaid medical, drug, and travel benefits. You apply through a participating dialysis facility, hospital, or VA facility, where a social worker can help. The KHC line is 800-222-3986.
If your income is limited, you may also qualify for a Medicare Savings Program or Medicaid. See our guides to help paying for Part B in Texas and Medicare and Medicaid in Texas.
Free help
You can compare dialysis facilities near you on Medicare.gov's Care Compare tool. For free, unbiased Medicare counseling, call HICAP at 1-800-252-9240 or 1-800-MEDICARE. Your dialysis center's social worker is also a good first call.
Common questions
Can I join a Medicare Advantage plan if I'm on dialysis?
Yes. Medicare says people with ESRD can choose either Original Medicare or a Medicare Advantage plan. If you look at a plan, check that your dialysis facility, kidney doctor, and any transplant center you may use are in its network.
I'm still working and have insurance through my job. Who pays first?
If you qualify for Medicare only because of kidney failure, your employer or union plan pays first for a 30-month coordination period, and Medicare pays second. After that, Medicare pays first. Tell your providers about all your coverage so they bill correctly.
Does Medicare pay for rides to dialysis?
Part B covers ambulance trips from home to the nearest dialysis facility only when traveling any other way could endanger your health. For regular rides, ask your dialysis social worker about other options, including Texas' Kidney Health Care program, which can reimburse mileage for eligible clients.
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