Medicare & Medicaid Explained.
In Plain English.
No insurance jargon. No fine print designed to confuse you. Just a clear, honest breakdown of how Medicare and Medicaid work — written specifically for kidney disease and dialysis patients.
Medicare vs. Medicaid
People mix these up constantly. They are two separate programs, run differently, with different rules for who qualifies.
| Question | Medicare | Medicaid |
|---|---|---|
| Who runs it? | Federal government (CMS) | Federal + State governments jointly |
| Who qualifies? | 65+, OR under 65 with disability (24+ months on SSDI), OR ESRD (any age) | Low-income individuals, families, children, pregnant women, elderly, and disabled. Rules vary by state. |
| Is it based on income? | No — based on age or medical condition | Yes — based on income and assets |
| What does it cover? | Hospital stays, doctor visits, prescriptions, dialysis, transplant | Varies by state — often includes what Medicare doesn't (dental, vision, long-term care) |
| Do you pay premiums? | Yes — Part B and D have monthly premiums | Usually little to none |
| Can you have both? | Yes — "dual eligible." Medicare pays first; Medicaid covers remaining costs. | |
Medicare Parts A, B, C, and D
Medicare is broken into four "parts." Each covers different things. Here's what each one does and what it costs in 2026.
Original Medicare = Parts A + B (+ optional standalone Part D). You pay 20% of most costs and there's no annual cap on out-of-pocket costs. Medicare Advantage plans have caps and often more benefits, but may restrict your choice of providers. For dialysis patients, verify your dialysis center is in-network before choosing a Medicare Advantage plan.
Medicare for Dialysis Patients (ESRD)
This is the most important section if you are on dialysis. Medicare has a special pathway for End-Stage Renal Disease — and it doesn't care how old you are.
If you have End-Stage Renal Disease (ESRD) — permanent kidney failure requiring dialysis or a kidney transplant to survive — you qualify for Medicare at any age. A newborn on dialysis qualifies. A 30-year-old qualifies.
The Three-Month Waiting Period
Medicare coverage for ESRD doesn't start immediately. For most patients on in-center hemodialysis, Medicare begins on the first day of the fourth month of dialysis. If you train for home dialysis (peritoneal dialysis or home hemodialysis), coverage can start as early as the first month you begin training.
The three-month waiting period means you need coverage in place before Medicare kicks in. Talk to your dialysis center's social worker about bridge coverage options. Don't wait until you're on dialysis to figure this out.
What Medicare Covers for ESRD
- All in-center hemodialysis sessions (3x per week standard)
- Peritoneal dialysis supplies and equipment (for home PD)
- Home hemodialysis training, equipment, and supplies
- Lab work: BMP, CBC, PTH, phosphorus, iron studies, and other dialysis-related labs
- EPO (erythropoietin) and iron injections to treat anemia of kidney disease
- Kidney transplant evaluation, surgery, and hospitalization
- Immunosuppressive drugs after transplant (Part B covers these)
- Dialysis-related medications prescribed by your nephrologist
After a Successful Transplant
If you receive a kidney transplant, your ESRD Medicare generally continues for 36 months after the transplant month. After that, if you are under 65 and no longer have ESRD, you may lose ESRD Medicare. Plan ahead — especially for immunosuppressive medications, which can cost thousands of dollars per month without coverage.
Medicare Abroad — What It Doesn't Cover
This is critical for MAVTG patients. Traveling while on dialysis is possible — but Medicare is not your safety net internationally.
Medicare generally does not pay for healthcare — including dialysis — received outside the United States, Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands. If you travel internationally and receive dialysis, you are typically responsible for 100% of the cost.
Narrow Exceptions
- Canada border exception: If you live in the U.S. near the Canadian border and a Canadian hospital is closer than the nearest U.S. hospital, Medicare may cover emergency care there.
- Mexico border exception: Same principle applies for some U.S.-Mexico border residents in emergencies.
- Ship exception: Medicare may cover care on a ship while in U.S. territorial waters (within 6 hours of a U.S. port).
How to Plan for International Dialysis Travel
- Arrange dialysis sessions at an international center before you travel — MAVTG can help with this
- Understand what the destination center charges: typically $150–$400 USD per session internationally
- Consider travel insurance that specifically covers dialysis (most standard travel insurance excludes pre-existing conditions)
- Ask about Medigap Plan F or G — some provide limited foreign emergency coverage (80% up to a lifetime maximum of $50,000), but dialysis for ESRD may not qualify as "emergency"
- Your dialysis center can provide records and a travel letter for the international center
We specialize in coordinating international dialysis travel. We research centers, verify protocols, help with cost estimates, and build itineraries around your treatment schedule. Contact us before your next trip.
Medigap / Supplement Plans
Original Medicare leaves gaps — the 20% coinsurance, deductibles, copays. Medigap plans are sold by private insurers to fill some or all of those gaps.
Medigap plans are standardized by the federal government. That means a Plan G from Blue Cross is identical in coverage to a Plan G from Humana — only the premium differs. Plans are labeled with letters, and each letter covers a specific set of gaps.
Plan C and Plan F (which cover the Part B deductible) are no longer available to people who were newly eligible for Medicare after January 1, 2020. If you already had one, you can keep it.
The Most Popular Plans
Plans C, D, F, G, M, and N include foreign travel emergency coverage: 80% of costs after a $250 deductible, up to a $50,000 lifetime maximum. However, this is for emergencies — scheduled dialysis sessions abroad are typically not covered. Verify with your insurer before you travel.
How Medigap Works with Medicare
Medicare pays its share first. Your Medigap plan then pays its share of the remaining approved costs. Medigap works with Original Medicare only — you cannot use a Medigap plan with Medicare Advantage.
Medicaid
Medicaid is a separate program from Medicare. It's for people with low income. States run their own Medicaid programs, so the rules, eligibility, and benefits vary significantly.
Who Qualifies?
- Low-income adults (the ACA expanded Medicaid in most states to adults under ~138% of the federal poverty level)
- Children (CHIP in many states)
- Pregnant women
- People with disabilities receiving SSI
- Elderly adults in nursing homes or needing long-term care
How Medicaid Differs from Medicare
| Feature | Medicaid | Medicare |
|---|---|---|
| Premium | Usually $0 | Part B: $185/month |
| Copays | Very low or none | 20% coinsurance after deductible |
| Dental/Vision | Often included (varies by state) | Not included in Original Medicare |
| Long-term care | Yes (nursing home, home care) | Limited (short-term skilled nursing only) |
| Drug coverage | Yes — state Medicaid drug lists | Part D (separate plan or Advantage) |
Dual Eligibility
If you qualify for both Medicare and Medicaid, you're called "dual eligible" or a "Medicare-Medicaid beneficiary." Medicare pays first for covered services. Medicaid helps pay what Medicare doesn't cover — premiums, deductibles, copays — and fills in with extra services Medicare doesn't offer. This can dramatically reduce your out-of-pocket costs.
Every state has its own Medicaid program. Search "Medicaid [your state]" or visit medicaid.gov/about-us/contact-us for a directory. Eligibility criteria and covered benefits differ significantly between states.
How to Enroll
Enrolling at the wrong time can cost you money for years in penalty premiums. Here's what you need to know.
Medicare Enrollment Periods
Online at ssa.gov/medicare, by phone at 1-800-772-1213 (SSA), or in person at your local Social Security office. You can also call 1-800-MEDICARE (1-800-633-4227) for guidance.
Key Phone Numbers
Save these. Real people answer these lines and can help you navigate enrollment, coverage questions, and billing disputes.
If you are on dialysis and receiving Medicare, you may also qualify for SSDI or SSI disability benefits. Read our Disability Benefits Guide — plain-language walkthrough of SSDI, SSI, how to apply, and what to do if you're denied.
Connect with other dialysis patients, transplant recipients, and caregivers who have navigated these same insurance questions. Join the MAVTG community and find people who understand your journey.
The Moore Foundation supports kidney disease patients through education and direct assistance. Learn how the Foundation can help you.
Disclaimer: This page is for general educational purposes only. It is not Medicare counseling, insurance advice, or legal advice. Medicare costs, rules, and coverage can change each year. Verify all costs and eligibility requirements at medicare.gov or by calling 1-800-MEDICARE. For personalized guidance, contact a SHIP counselor (free, unbiased, and available in every state) or a licensed Medicare insurance broker. MAVTG is not affiliated with Medicare, Medicaid, the Social Security Administration, or any insurance company.