August 28, 2026
3:47 am

Home Dialysis: Equipment and Household Costs

You do not buy the dialysis machine. The certified dialysis facility supplies and maintains the cycler or hemodialysis machine and the supplies as part of the bundled payment Medicare makes to the facility – what your household actually pays for is electricity, water, plumbing, storage space, and time. Nearly every family starting home dialysis budgets for the wrong thing.

There is one timing rule worth knowing in the first day. For most people, Medicare coverage based on end-stage renal disease begins the fourth month of dialysis. But when a patient participates in a home dialysis training program, coverage can begin the first month of dialysis, subject to the program’s conditions. That is potentially three months of coverage, and it depends on a decision made early. Confirm the current rule and your specific situation with the Social Security Administration, which takes the ESRD Medicare application, and with your dialysis facility’s social worker.

Below is what to do in the first seventy-two hours, then in the first month. This is education, not medical, legal or benefits advice; the facility social worker and your State Health Insurance Assistance Program counselor are both free and are the right people for your specific case.

In This Article

Hours 0-24: The Two Calls That Change the Money
Hours 24-48: Walk the House With a Tape Measure
Hours 48-72: Call the Utility Company
The First Month: The Twenty Percent That Is Not Covered
The First Month: Transportation, Even for Home Patients
Where a Life Insurance Policy Fits, Told Straight
Who to Complain To When Something Goes Wrong
Frequently Asked Questions

Hours 0-24: The Two Calls That Change the Money

Call one: the dialysis facility’s social worker. Every Medicare-certified dialysis facility is required to have a qualified social worker with a master’s degree, and that person is free to you. Ask four questions and write down the answers: Is home training available here or do I need a referral to another unit? What is the training start date? Will coverage begin the first month if we enter home training? And can you screen us for the American Kidney Fund’s Health Insurance Premium Program, which pays health insurance premiums for eligible dialysis patients?

Call two: the Social Security Administration, to file the ESRD Medicare application. Medicare based on ESRD is available regardless of age when work-history requirements are met, which is why a 41-year-old and an 81-year-old are on the same page here. Ask about Part A, Part B, and the enrollment timing implications of home training.

One more thing to establish today if the patient is under 65 and still working, or is covered by a spouse’s employer plan: the coordination period. When an employer group health plan is in play, that plan generally pays first for a defined coordination period, commonly stated as thirty months, before Medicare becomes primary. That has enormous financial consequences and it is easy to get wrong. Ask the plan administrator in writing which payer is primary and from what date.

Hours 24-48: Walk the House With a Tape Measure

This is where the real household cost lives, and it is entirely predictable if you look before the equipment arrives.

Storage. Peritoneal dialysis supplies typically arrive as a monthly delivery of roughly thirty boxes. Measure the space now. Families clear a spare bedroom or a garage corner; a hallway is not enough.
Electrical. The machine needs a dedicated, properly grounded outlet in most setups. Ask the training nurse for the exact electrical specification before you call an electrician.
Plumbing and water. Home hemodialysis has water requirements that peritoneal dialysis does not. Plumbing and electrical modifications commonly run in the range of roughly $1,500 to $10,000 as of 2026 depending on the home and the modality; get two written quotes and ask the facility whether any of it is covered or reimbursed, because policies differ by provider organization.
Landlord or association permission. If you rent or live in a condominium, get written consent before anyone drills anything.

If mobility modifications are also in play – a ramp, a wider doorway, a bathroom change – price them together rather than sequentially. Our page on what a home health aide does is worth reading now too, because the care-partner burden is the most underestimated cost in this whole picture.

Hours 48-72: Call the Utility Company

Almost nobody does this and it is free money. Most electric and water utilities operate a medical baseline or critical care program that provides a larger allowance at a lower rate, and often protection from shutoff, for households with medically necessary equipment. It requires a form signed by the physician. Call the utility, ask specifically for the medical baseline or life-support customer program, and ask for the form.

The numbers to expect. Running a home hemodialysis machine several times a week adds meaningfully to electricity and water use; households commonly report an increase in the range of roughly $100 to $250 a month as of 2026, varying widely by modality, treatment frequency, local rates and climate. Treat that as a range. Some dialysis provider organizations offer a utility stipend or reimbursement to home patients – ask the facility directly, in writing, because it is not always volunteered.

Also in this window: confirm what happens in a power outage, register the household with the utility’s medical registry if one exists, and ask the training nurse for the manual or emergency procedure.

Cost Item	Who Pays	Typical Range (2026)	Who to Ask
Machine, cycler, supplies	Covered in the facility’s bundled payment	No household purchase	Dialysis facility
Added electricity and water	Household	Roughly $100-$250/month	Utility medical baseline program
Plumbing and electrical modifications	Household, sometimes reimbursed	Roughly $1,500-$10,000 one-time	Facility; get two written quotes
20% Part B coinsurance	Household unless supplemented	Uncapped and recurring	Medigap, Medicaid, American Kidney Fund
Transportation to training and clinic visits	Household	Varies by distance	Medicaid NEMT; Area Agency on Aging

The First Month: The Twenty Percent That Is Not Covered

Medicare Part B generally pays 80 percent of the approved amount for dialysis services and related items after the annual deductible, leaving 20 percent with no cap. On the cost of ongoing dialysis, an uncapped 20 percent is a large recurring exposure, and it is the reason supplemental coverage matters more here than in almost any other situation.

Three ways households cover it, and all three should be checked in month one:

Medigap. Federal law guarantees Medigap issue at 65; for people under 65 with ESRD, availability depends entirely on state law, and a number of states do require issuance while others do not. Your SHIP counselor can tell you your state’s rule for free.
Medicaid. Many dialysis patients qualify, and dual eligibility generally covers the coinsurance. Apply through the state Medicaid agency.
The American Kidney Fund’s Health Insurance Premium Program, which assists eligible dialysis patients with health insurance premiums. Ask the facility social worker to submit the application.

Also confirm the drug side. Under the ESRD bundled payment, many dialysis-related drugs are included in the facility’s payment; others, including some oral medications, run through Part D with their own cost sharing. If a specialty drug is involved, copay assistance for specialty drugs lays out the manufacturer and foundation options and their eligibility limits.

The First Month: Transportation, Even for Home Patients

Home dialysis reduces trips but does not eliminate them. There is training, typically several weeks of daily or near-daily sessions at the start. There are monthly clinic visits, lab draws, access procedures, and the periodic in-center treatment when something goes wrong with the home setup.

Budget the mileage honestly, and check three sources of help: Medicaid non-emergency medical transportation if eligible, the Area Agency on Aging’s transportation program, and hospital or dialysis-organization patient assistance funds. The transportation arithmetic for dialysis works the same way here and is worth running with your actual distances.

If oxygen or other equipment is also in the home, note that different rules apply to different equipment categories – oxygen equipment rental follows the durable medical equipment rules rather than the dialysis bundle, and the two get confused constantly.

Where a Life Insurance Policy Fits, Told Straight

Two truths that point in opposite directions, and the household needs both.

The near-term problem is small and recurring. The utility increase is roughly $100 to $250 a month. The plumbing is a one-time $1,500 to $10,000. The 20 percent coinsurance is the big recurring one, and the right fix for it is coverage – Medigap where available, Medicaid, or the American Kidney Fund program – not an asset sale. Selling a life insurance policy to cover a $180 utility increase would be a serious error, and anyone suggesting it should be treated with suspicion.

The long-term picture is different. A person on dialysis has a health profile that the secondary market prices differently than a healthy person of the same age, which means a policy that would not have attracted an offer five years ago sometimes does now. Where the household faces a genuine long-run funding problem – a spouse leaving work to be the care partner, a policy premium that has become unaffordable, or coverage that is simply no longer needed – a review is legitimate. If the illness is terminal under the statutory definitions, a viatical settlement is a different transaction with different tax treatment; if not, an ordinary settlement analysis applies. Start with what dialysis means for a policy, then what a viatical settlement is and what policies actually pay.

Check the free option first. Many permanent policies and some group policies carry an accelerated death benefit or chronic illness rider that pays part of the death benefit early, with no fees and, when the statutory conditions are met, favorable tax treatment under Internal Revenue Code section 101(g). Call the carrier and ask before considering any sale. Confirm any tax outcome with your own CPA.

Selling is the wrong answer when the death benefit is under roughly $100,000; when the policy is a small final-expense policy, particularly one sitting inside a state Medicaid burial exclusion, since Medicaid eligibility is frequently central for dialysis households; when a surviving spouse will need the coverage; when an existing rider already provides what is needed; and whenever the actual problem is a recurring monthly cost rather than a lump-sum need.

If you want an independent read – including the answer that you should leave the policy alone – send the policy cover page for a free, no-obligation review or call (732) 978-9575. Pine Lake Legacy provides education and reviews only and does not give medical, legal, tax or benefits advice.

Who to Complain To When Something Goes Wrong

Three named channels, all free. The ESRD Network for your region – CMS contracts with a set of regional ESRD Networks that handle patient grievances about dialysis facilities and help with placement problems; the facility must post the Network’s contact information. The state survey agency, which licenses and inspects dialysis facilities. And your SHIP counselor for coverage and billing disputes.

If you are weighing home dialysis against other care settings, or a move is on the table, home equity versus a policy sale compares the two funding routes people most often consider, and it is worth reading before either one gets started rather than after.

Frequently Asked Questions

Do we have to buy the dialysis machine?

No. The Medicare-certified dialysis facility supplies and maintains the machine, cycler and supplies as part of the bundled payment it receives. What the household actually pays for is added electricity and water, any plumbing or electrical modification, storage space, transportation and the care partner’s time.

Does Medicare coverage really start earlier with home dialysis?

For most people ESRD-based Medicare begins the fourth month of dialysis, but participation in a home dialysis training program can allow coverage to begin the first month, subject to the program’s conditions. That is potentially three months of coverage. Confirm with the Social Security Administration and the facility social worker immediately.

How much do utilities go up?

Households commonly report an increase in the range of roughly $100 to $250 a month as of 2026, varying widely by modality, treatment frequency, local rates and climate. Ask your utility for its medical baseline or critical care program, which requires a physician-signed form, and ask the facility whether it offers a utility stipend.

What covers the 20 percent Medicare does not pay?

Medigap where your state permits issuance to people under 65 with ESRD, Medicaid if you qualify, or an employer or retiree plan. The American Kidney Fund’s Health Insurance Premium Program assists eligible dialysis patients with premiums. Your free State Health Insurance Assistance Program counselor can tell you your state’s Medigap rule.

My spouse’s employer plan covers us. Does Medicare still matter?

Yes, and the order of payment matters enormously. When an employer group health plan is involved, it generally pays first for a defined coordination period, commonly stated as thirty months, before Medicare becomes primary. Get the plan administrator’s written confirmation of which payer is primary and from what date.

Should we sell a life insurance policy to pay for all this?

Not for the utility increase or the plumbing, which are small and recurring or one-time and modest. Check first whether the policy has an accelerated death benefit or chronic illness rider, which costs nothing to use. A sale is a separate question that only makes sense for larger policies and a genuine long-run funding gap.

Who do we complain to about the dialysis facility?

The regional ESRD Network that CMS contracts with for your area handles patient grievances and placement problems, and the facility is required to post its contact information. The state survey agency licenses and inspects facilities. Your SHIP counselor handles coverage and billing disputes. All three are free.

Find out what your policy is worth — free, confidential, no obligation.

A 15-minute educational review covers your eligibility, every alternative, and a realistic view of what each path would net you.

Call (732) 978-9575 · Request a review online →

Table of Contents