Dialysis without insurance can cost $300 to $500 per session, and most people on hemodialysis need three sessions a week. That adds up to roughly $50,000 to $80,000 a year out of pocket. The good news: almost no one in the U.S. actually pays that full amount, because kidney failure unlocks a unique set of government programs and financial assistance that most other conditions don’t. Here’s how to navigate them.
Medicare Covers Dialysis at Any Age
The United States treats kidney failure differently from virtually every other medical condition. If your kidneys have permanently failed and you need regular dialysis, you qualify for Medicare regardless of your age. This is the single most important thing to know if you’re uninsured. Most people think of Medicare as insurance for those 65 and older, but Congress created a special exception for end-stage renal disease (ESRD) decades ago.
To qualify, all three of these must be true:
- Your kidneys no longer function well enough to sustain life
- You need regular dialysis or have received a kidney transplant
- You (or your spouse or parent) have worked long enough to earn Social Security credits, are already receiving Social Security or Railroad Retirement benefits, or worked as a government employee
The work-history requirement trips some people up. You generally need about 10 years of work (40 quarters) where Social Security taxes were withheld. But you don’t have to be the one who worked. If your spouse or a parent you depend on meets that threshold, you qualify through them. Coverage typically begins on the first day of the fourth month after you start dialysis, though starting home dialysis training can move that date earlier. During that gap, other programs described below can help bridge the cost.
Medicaid for Low-Income Patients
If your income is low enough, Medicaid may cover dialysis immediately, with no waiting period. Eligibility rules vary by state, but in the 40 states (plus Washington, D.C.) that expanded Medicaid, most adults earning up to 138% of the federal poverty level qualify. That’s roughly $20,800 a year for an individual in 2024.
Even in states that didn’t expand Medicaid, kidney failure often qualifies you through disability-related pathways. Many states fast-track applications when a patient has ESRD. One important wrinkle: if you have Medicaid and also qualify for Medicare through ESRD, most states require you to apply for Medicare as well. Medicaid then acts as secondary coverage, picking up costs that Medicare doesn’t, like copays and certain medications. Your dialysis clinic’s social worker can help coordinate this, and some states, including New York, offer free “facilitated enrollers” who walk you through the Medicare application in person.
Emergency Medicaid for Undocumented Immigrants
People without legal immigration status generally can’t get standard Medicaid, but Emergency Medicaid exists in every state to cover life-threatening conditions. Whether that covers scheduled, ongoing dialysis depends on where you live. As of recent policy changes, at least 12 states have modified their Medicaid rules to allow routine dialysis for undocumented immigrants under Emergency Medicaid. Washington state reimburses scheduled dialysis through Emergency Medicaid by including it in the definition of covered emergency services. Colorado made a similar change in 2019 by adding ESRD to its state definition of “emergency medical condition.”
If you live in a state that hasn’t made this change, Emergency Medicaid may only cover dialysis performed in an emergency room when your condition becomes immediately life-threatening. This leads to a harmful cycle of waiting until you’re critically ill, getting emergency treatment, and repeating the process. Ask a hospital social worker or a local kidney disease nonprofit whether your state covers scheduled dialysis through Emergency Medicaid.
The American Kidney Fund’s Premium Program
The American Kidney Fund (AKF) runs the Health Insurance Premium Program, or HIPP, which pays monthly insurance premiums for dialysis patients who can’t afford them. This program doesn’t pay for dialysis directly. Instead, it helps you get or keep insurance that covers dialysis, which is often more valuable.
HIPP grants cover premiums for a wide range of plans: Medicare Part B, Medigap policies, Medicare Advantage, Marketplace plans, employer-sponsored insurance, COBRA, and even Medicaid in states that charge premiums. To qualify, you must be receiving dialysis for ESRD in the United States, have already selected and enrolled in a health plan, and demonstrate that you can’t afford the premiums on your own. You also need to show you’ve looked into other forms of assistance first, like Medicaid or state programs.
Applications go through the AKF’s online Grant Management System at gms.kidneyfund.org. The process has two steps: first you complete a patient profile to check eligibility, then, if approved, you submit a formal grant request. Grants are awarded first-come, first-served, so apply as soon as you’re eligible. If you later receive a kidney transplant while on HIPP, the fund continues paying your premiums through the end of your plan year, provided you’ve been receiving assistance for at least three consecutive months before the transplant.
VA Benefits for Veterans
Veterans enrolled in VA health care have dialysis covered as part of the standard medical benefits package, regardless of whether the kidney disease is connected to military service. Both hemodialysis and peritoneal dialysis (including home-based options) are covered. If the nearest VA facility can’t provide dialysis, the VA is required to arrange care at a non-VA clinic in your community at no extra cost to you.
If you’re a veteran who hasn’t enrolled in VA health care, it’s worth applying now. There’s no premium for most veterans, and the enrollment process can often be done online through VA.gov. Even veterans with other-than-honorable discharges may qualify for certain health benefits, so don’t rule yourself out without checking.
Hospital and Clinic Financial Assistance
Every nonprofit hospital in the United States is required by federal law to maintain a written financial assistance policy, sometimes called charity care. These policies must offer free or reduced-cost care to patients who can’t afford to pay, and the hospital must actively publicize the program. You should see notices about financial assistance on billing statements, in public displays near the emergency room and admissions areas, and on the hospital’s website.
This matters because many dialysis patients receive initial treatment in hospital settings before transitioning to outpatient clinics. If you’re hit with a large bill during that early period before Medicare or Medicaid kicks in, request the hospital’s financial assistance application. Eligibility is typically based on income relative to the federal poverty level, and approval can reduce your bill significantly or eliminate it entirely. You’re entitled to a plain-language summary of the policy and a paper application at no charge.
Large for-profit dialysis providers also sometimes offer their own hardship programs, though these are less standardized. Ask the clinic’s social worker directly. Dialysis clinics employ social workers specifically to help patients navigate financial barriers, and they deal with these situations regularly.
Help With Medication Costs
Dialysis itself is only part of the expense. Kidney failure patients often need medications to manage anemia, control phosphorus levels, and support other functions the kidneys can no longer handle. Several drug manufacturers offer patient assistance programs specifically for people without insurance or Medicare.
The Amgen Safety Net Foundation provides medications like those used to treat anemia in dialysis patients directly to people who lack insurance or Medicare coverage. Other manufacturers run similar programs for phosphorus-lowering drugs and related medications. Beyond manufacturer programs, several broader resources exist:
- State Kidney Programs: About 15 states run programs that cover outpatient medications and other costs for dialysis patients. Ask your social worker whether your state has one.
- Medicare Part D Extra Help: If you qualify for Medicare through ESRD, this program lowers prescription costs like deductibles and copays for people with limited income.
- NeedyMeds: A nonprofit that maintains a searchable database of programs that lower medication and healthcare costs.
- Patient Access Network (PAN) Foundation and The Assistance Fund (TAF): Both provide financial help with copays, deductibles, and out-of-pocket drug costs for people with chronic conditions including kidney disease.
How to Start Right Now
If you need dialysis and have no insurance, the first conversation to have is with the social worker at your dialysis clinic or hospital. They can assess which programs you’re likely eligible for and help you apply. While that process unfolds, here’s a practical sequence to follow:
Apply for Medicaid immediately if your income is low. This can provide coverage fastest, sometimes within days in emergency situations. Simultaneously, file a Medicare application based on ESRD, even if you’re under 65, because this will become your primary coverage once the waiting period passes. Register with the American Kidney Fund’s HIPP program if you have any form of insurance but can’t afford the premiums. Request financial assistance applications from any hospital or clinic billing you. And if you’re a veteran, contact your nearest VA medical center to enroll in VA health care.
The system is complicated, but the underlying reality is straightforward: kidney failure is one of the few conditions where the federal government guarantees coverage to nearly everyone, regardless of age. The challenge is getting through the paperwork and bridging any gaps in the timeline. A dialysis social worker is your most important ally in that process, and their help is free.