Medicare will pay dialysis centers about 2.7% more in 2027 under a final rule the Centers for Medicare & Medicaid Services issued Oct. 28, a change that also raises what patients with kidney failure pay out of pocket for treatment and boosts payments for training people to do dialysis at home.
The CMS fact sheet says the base payment for a single outpatient dialysis treatment will rise to $297.52 on Jan. 1, 2027, up $15.81 from this year’s $281.71. Medicare expects to pay $7.0 billion to roughly 7,600 dialysis facilities next year under the system, according to the agency.
The rule is final and takes effect Jan. 1, 2027.
What did CMS finalize for 2027?
The annual rule sets how Medicare pays for outpatient dialysis for people with end-stage renal disease, or ESRD, which is permanent kidney failure that requires dialysis or a transplant. Most of the increase comes from a 1.9% inflation update, according to the final rule filed for public inspection with the Federal Register.
About $12.85 of the base-rate increase reflects the cost of phosphate binders, pills many dialysis patients take to control phosphorus in their blood. Medicare began folding those drugs into its bundled dialysis payment on Jan. 1, 2025, and the new rule completes that shift by permanently building their cost into the base rate, CMS said.
Other changes in the rule include:
- Home dialysis training: the add-on payment for home and self-dialysis training rises from $95.60 to $138.00 per session, and facilities can now be paid for training during a patient’s first four months of dialysis.
- Small centers: CMS doubled the cutoff for its low-volume payment boost from 4,000 to 8,000 treatments a year and split the adjustment into six tiers, so more smaller facilities qualify for extra pay.
- Children: CMS updated payment adjustments for pediatric patients as a temporary pediatric add-on ends.
- Quality program: starting with payment year 2029, a measure tracking high phosphorus levels in patients replaces a calcium-reporting measure, and two reporting measures are dropped, including COVID-19 vaccination of staff.
Will Medicare patients pay more for dialysis?
Yes, modestly. Under Original Medicare, patients generally pay 20% of the Medicare-approved amount for outpatient dialysis after meeting the Part B deductible, according to Medicare.gov. Because the approved amount is rising, so is that share.
CMS estimates beneficiary coinsurance payments will increase 2.7% in 2027, or about $50 million in total across all patients, according to the final rule. How much any one person pays depends on their coverage: Medigap policies and Medicare Advantage plans may cover some or all of that 20%.
Medicare says patients must also keep paying their monthly Part B premium, plus Part D premiums if they have drug coverage.
Why is CMS paying more for home dialysis training?
The administration has made home dialysis a priority. HHS released a kidney care national plan this month aimed at catching kidney disease earlier and opening up dialysis options, which HNC reported on Oct. 21.
Medicare Part B covers home dialysis training for both the patient and the person helping them, as well as home equipment and supplies, according to Medicare.gov. Training must come from a Medicare-certified facility. In the final rule, CMS said patients and caregivers who commented urged the agency to prioritize patient choice and outcomes such as fatigue, recovery time and the ability to work or travel.
What should dialysis patients and caregivers do now?
Nothing changes in how patients get treatment on Jan. 1. But the rule is a useful prompt to review costs and options before the new year:
- Check your coverage for 2027. Medicare open enrollment runs through Dec. 7. Compare how your plan or Medigap policy handles the 20% dialysis coinsurance.
- Compare dialysis centers. Medicare’s Care Compare tool lists Medicare-certified dialysis facilities near you, with their quality ratings and the types of dialysis they offer.
- Ask about home dialysis. If you are interested in dialyzing at home, ask your kidney care team whether you are a candidate and which nearby facilities provide training.
- Get help with problems. Regional ESRD Networks help patients with concerns about their care, and 1-800-MEDICARE (1-800-633-4227) answers coverage questions.
Key Takeaways
- CMS finalized a 2027 dialysis base rate of $297.52 per treatment, up $15.81, for about a 2.7% overall increase in Medicare dialysis payments.
- Phosphate binders are now permanently built into the dialysis payment, adding $12.85 to the base rate.
- Home dialysis training pay rises to $138.00 per session from $95.60.
- CMS estimates patient coinsurance rises about 2.7% in 2027, roughly $50 million total; Medigap or Medicare Advantage may cover some of it.
Frequently Asked Questions
When does the 2027 Medicare dialysis rule take effect?
The final rule takes effect Jan. 1, 2027.
How much will Medicare pay per dialysis treatment in 2027?
The base rate will be $297.52 per treatment, up from $281.71 in 2026, before adjustments for factors such as patient characteristics and location.
Will my dialysis coinsurance go up?
Likely a little. Original Medicare patients generally pay 20% of the Medicare-approved amount after the Part B deductible, and CMS estimates total coinsurance payments rise about 2.7% in 2027. Medigap or Medicare Advantage may cover some or all of it.
Does Medicare cover home dialysis training?
Yes. Medicare Part B covers home dialysis training for the patient and the person helping them, provided by a Medicare-certified facility.
Where can I compare dialysis centers?
Medicare’s Care Compare tool at Medicare.gov lists Medicare-certified dialysis facilities with quality information.
Featured image: A patient’s arm connected to a dialysis line. Illustrative photo. (Photo by Anna Frodesiak, CC0, via Wikimedia Commons)
