Dialysis in the United States typically costs between $90,000 and $100,000 per year for in-center hemodialysis, though what you actually pay out of pocket depends heavily on your insurance. Medicare covers most Americans on dialysis, but even with coverage, the remaining costs for medications, transportation, and copays add up quickly.
What a Single Dialysis Session Costs
The price of a single hemodialysis session varies dramatically based on who’s paying. Medicare’s base reimbursement rate for one session sits around $240, while the median price private insurers paid was $1,476 per session between 2012 and 2019, according to data published in JAMA Network Open. That’s more than six times the Medicare rate for the same treatment in the same chair.
Most people on dialysis need three sessions per week, totaling about 156 sessions per year. At private insurance rates, that works out to roughly $230,000 annually before any negotiated discounts. At Medicare rates, the same treatment costs the program closer to $37,000 per year in facility payments alone. The gap between these two numbers explains why insurance status is the single biggest factor in what dialysis costs you or your insurer.
Private insurance prices have also been climbing. From 2012 to 2019, the median price private insurers paid per session rose 22.7%, from $1,349 to $1,655. Medicare rates, by contrast, barely moved during the same period, increasing just 0.3%.
In-Center vs. Home Dialysis Costs
There are two main types of dialysis: hemodialysis (typically done at a clinic three times per week) and peritoneal dialysis (usually done daily at home). The costs break down differently for each.
Hemodialysis patients tend to have higher drug costs. Annual injectable medication spending for hemodialysis runs about twice as high as for peritoneal dialysis, largely because clinic-based treatment requires more administered medications during sessions. Hemodialysis patients also rack up higher bills for outpatient services unrelated to dialysis itself, roughly 44% more than peritoneal dialysis patients. On the other hand, the non-drug costs directly tied to dialysis treatment (supplies, facility fees) are actually about 15% lower for hemodialysis compared to peritoneal dialysis.
Home hemodialysis is a third option that carries significant startup costs. One program tracked comprehensive first-year costs at around $59,000 per patient, which included home remodeling (plumbing and electrical upgrades), training, equipment, medications, and consumables. By the second year, costs dropped to roughly $49,000 as the one-time setup expenses fell away. Your home may need water treatment systems, upgraded electrical outlets, and dedicated plumbing, though insurance or the dialysis provider sometimes covers these modifications.
Costs Beyond the Treatment Itself
The sticker price of dialysis doesn’t capture everything you’ll spend. Medications alone add thousands per year. Phosphate binders, which nearly every dialysis patient takes to prevent dangerous mineral buildup, cost about $5,300 to $5,500 per year in insurance spending per patient. Insulin, cancer-related drugs, and blood pressure medications are also among the top prescription costs for people with kidney failure. These costs are separate from the drugs administered during dialysis sessions themselves.
Transportation is another major expense that catches people off guard. In-center hemodialysis requires three round trips per week to a clinic. Original Medicare does not cover routine transportation to dialysis, only emergency ambulance rides. Some Medicare Advantage plans include non-emergency medical transportation, but coverage varies widely. Some plans offer unlimited rides, others cap the number of trips per month, and many require prior approval. Without coverage, you’re looking at rideshare costs, gas money, or medical transit services out of your own pocket, 156 times a year.
If you need hemodialysis, you’ll also need a surgical procedure to create a vascular access point, typically in your arm. When this is done as a planned outpatient procedure, facility costs run about $2,500 to $3,500. If it happens as an emergency inpatient procedure, costs jump to $25,000 to $40,000. Planning ahead and getting access surgery before you urgently need dialysis saves significant money and generally produces better long-term results.
What You Pay With Medicare
Most people with end-stage kidney disease qualify for Medicare regardless of age, which is unusual. Medicare Part B covers 80% of dialysis costs, leaving you responsible for the remaining 20% coinsurance. On a $37,000 annual Medicare bill, that 20% still works out to roughly $7,400 per year in out-of-pocket costs for dialysis alone, before medications, transportation, and supplemental insurance premiums.
The annual Part B deductible is $257 for 2025, which you’ll need to meet before coverage kicks in. Medicare Part D covers prescription medications like phosphate binders, but drugs given during dialysis sessions (such as medications that stimulate red blood cell production) are bundled into the Part B dialysis payment.
Many dialysis patients also carry a Medigap supplemental plan or enroll in Medicare Advantage to reduce that 20% coinsurance. These plans have their own monthly premiums, typically ranging from $50 to over $300 depending on the plan and your location.
What You Pay With Private Insurance
If you have employer-sponsored or marketplace insurance, your plan is likely paying far more per session than Medicare would, but your personal costs depend on your plan’s deductible, copay structure, and out-of-pocket maximum. Most private plans have annual out-of-pocket caps between $3,000 and $9,000 for an individual, which dialysis patients almost always hit within the first few weeks of the year.
There’s an important catch with private insurance and kidney disease. Once you qualify for Medicare due to kidney failure, there’s a 30-month coordination period during which your private insurance remains the primary payer. After that, Medicare becomes primary. Because private insurers pay so much more per session, some dialysis providers have financial incentives tied to which type of insurance their patients carry.
Financial Assistance Programs
The American Kidney Fund runs the largest assistance program for dialysis patients. Its Health Insurance Premium Program provided grants to nearly 58,000 patients in 2024, covering premiums for Medicare Part B, Medigap, Medicare Advantage, Medicaid, marketplace plans, employer plans, and COBRA. To qualify, you need to be receiving dialysis in the U.S., already be enrolled in a health insurance plan, have explored other assistance options first, and demonstrate that you cannot afford your premiums.
Grants are sent directly to insurance companies, deposited into your bank account, loaded onto a debit card, or mailed as a check. The program is designed to keep patients insured so they can continue accessing treatment without catastrophic personal costs.
Beyond premium help, many states offer Medicaid coverage for dialysis patients who meet income requirements, and some dialysis providers have their own charitable care programs. Social workers at dialysis clinics are typically the best starting point for identifying which programs you qualify for, since eligibility varies by state, income, and insurance status.