Dialysis means many rides each week
Most people get hemodialysis at a dialysis center. Treatments usually happen three times a week, on a fixed schedule such as Monday, Wednesday and Friday, or Tuesday, Thursday and Saturday. Each session lasts about 4 hours.
That means you may need a ride to and from the center several times every week. When you look for help, ask about rides that repeat on a set schedule, not just one trip at a time.
Some people do dialysis at home instead. Your health care team can help you decide which type of dialysis fits your situation.
What Original Medicare pays for
You have Original Medicare unless you choose a Medicare Advantage Plan or another type of Medicare health plan. Original Medicare covers ambulance rides from your home to the nearest dialysis facility and back only when other forms of transportation could endanger your health.
For scheduled, repeat ambulance rides that aren’t emergencies, the ambulance company must get a written order from your doctor first. The order must say the ambulance is medically necessary. It must be dated no earlier than 60 days before the ride.
If you get scheduled, non-emergency ambulance rides 3 or more round trips in a 10-day period, or at least once a week for 3 weeks or more, a Medicare prior authorization program may apply. Prior authorization means asking Medicare to approve the rides ahead of time. You or the ambulance company may ask for it. If it isn’t approved and you keep getting the rides, Medicare will deny the claim and the ambulance company may bill you for all charges.
For rides by car, van or taxi, Medicare’s own guide says that in most cases, Medicare doesn’t pay for transportation to dialysis facilities. The full rules for ambulance rides are in the Medicare guide on this site.
When Medicare coverage starts
People with End-Stage Renal Disease (ESRD) can get Medicare. ESRD means permanent kidney failure that needs regular dialysis or a kidney transplant.
If you’re on dialysis, Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. For example, if you start dialysis on July 1, your coverage begins on October 1. It can start sooner if you take part in a home dialysis training program during the first 3 months.
If you have a health plan through an employer, that plan may pay for the first 3 months. To ask about your own start date, call 1-800-MEDICARE.
Medicare Advantage plans may offer rides
Medicare Advantage Plans are Medicare plans sold by private companies. Since January 1, 2021, all people with ESRD who are eligible for Medicare can join one.
If you’re in a Medicare Advantage Plan, the plan may cover some non-ambulance transportation to dialysis facilities and doctors. Read your plan materials or call the plan to find out. These extra benefits are generally limited, so ask exactly what is covered before you join.
In many plans, you can only use providers in the plan’s network. Before you join, check that your dialysis facility and kidney doctor are in the network.
Medicaid may cover rides to dialysis
Federal rules say each state’s Medicaid program must make sure members have necessary transportation to and from their medical providers. This is often called non-emergency medical transportation, or NEMT.
Medicaid may give you a ride if you have no other reasonable way to get to your appointment, such as not having a working car or a driver’s license. Rules differ by state, and you may need approval first. Rides might be by taxi, car, van, bus or subway, and you might share the ride.
Because dialysis repeats every week, some state ride programs let the dialysis facility set up a standing order. A standing order books your regular trips ahead of time, so you don’t have to call for every ride. In Wisconsin, for example, the company that runs Medicaid rides describes a standing order as regularly reoccurring rides, such as for a Monday, Wednesday and Friday dialysis patient. Ask your state’s ride program if it offers this.
If you have both Medicare and full Medicaid, Medicaid may cover services Medicare doesn’t, including transportation to medical services. The Medicaid guide on this site explains how to book a ride.
Ask your dialysis social worker and kidney charities
Dialysis facilities have social workers on the care team. If you need help with rides that aren’t by ambulance, Medicare suggests you talk to the social worker at your dialysis facility to find out your options.
The American Kidney Fund (AKF) offers Safety Net grants for health costs insurance doesn’t cover. AKF says typical costs include transportation to and from dialysis. In most U.S. states or territories, the grant amount is $200 a year or every 365 days. To apply, talk to your dialysis center’s social worker or call AKF at 800-795-3226.
In Pennsylvania, National Kidney Foundation offices help run a state program that may pay back part of the cost of travel to and from dialysis for people who qualify.
Finding a closer center and getting help
A shorter trip can make rides easier to arrange. You have the right to get treatment at another facility at any time, but this could mean changing doctors. You can use Medicare’s Care Compare tool to find a dialysis facility close to you and compare addresses, phone numbers, maps and directions.
If you don’t have a computer or smartphone, your local library or senior center may help you look. You can also call 1-800-MEDICARE for help comparing dialysis facilities.
ESRD Networks help with complaints about dialysis facilities. If you have Original Medicare and need dialysis during a disaster or emergency, your ESRD Network can help you find out who to contact for transportation to dialysis. Call 1-800-MEDICARE to get your ESRD Network’s phone number.