Medicare Sets New 2027 Dialysis Payment Rules — What Kidney Patients Need to Know

Medicare is revising how much it reimburses dialysis facilities in 2027, with new rules that affect treatment payments, medications, and quality standards for people living with kidney failure.

The Centers for Medicare & Medicaid Services (CMS) said the updated dialysis payment rate will rise to $297.52 per treatment, up from $281.71 in 2026. The agency estimates the change will lift total Medicare payments to dialysis facilities by about 2.7%.

The final rule, which was issued in late 2026 and takes effect at the start of 2027, also includes updates tied to medications, smaller dialysis facilities, home dialysis training, and quality reporting.

For Medicare beneficiaries who receive dialysis, understanding these changes can help them ask better questions about treatment options, coverage, and possible out-of-pocket costs.

Dialysis Reimbursement Will Rise in 2027

The largest financial change affects Medicare’s End-Stage Renal Disease Prospective Payment System, which sets how dialysis facilities are paid for treating patients with permanent kidney failure.

Under the new rule, the base payment increases by $15.81 per treatment, from $281.71 in 2026 to $297.52 in 2027.

CMS says Medicare expects to spend about $7 billion on dialysis services delivered by roughly 7,600 facilities during 2027.

The payment system combines dialysis treatment and many related services into one reimbursement amount, with adjustments based on patient characteristics, geographic costs, and other factors.

It is important to note that the $297.52 figure is Medicare’s base payment rate, not the amount every patient will personally owe.

Kidney Drugs Will Be Folded Into Dialysis Payments

Another major change involves phosphate binders, medications often prescribed for people with kidney failure to help control phosphorus levels in the blood.

Starting in 2027, CMS will permanently include the cost of these drugs in the standard dialysis payment rate, adding $12.85 to the base amount.

High phosphorus levels can lead to serious health issues, including bone and cardiovascular complications, which makes phosphorus management an important part of kidney care.

This update completes a transition that began in early 2025, when Medicare started incorporating phosphate binders into its dialysis payment structure.

Patients should ask their dialysis providers how phosphate binder medications will be supplied and billed in 2027, especially if they currently get them through a separate pharmacy.

Smaller Facilities Will See New Payment Adjustments

Medicare is also changing the way it pays smaller dialysis facilities, which can have higher operating costs because they treat fewer patients.

The new rule raises the eligibility threshold for the Low-Volume Payment Adjustment from 4,000 to 8,000 dialysis treatments per year.

CMS is also expanding the adjustment structure from two tiers to six, which should allow reimbursement to better reflect differences in facility size.

These changes may matter most for patients who rely on smaller dialysis centers, including those in rural areas where other treatment options may be limited.

Even so, the new structure does not guarantee that any individual facility will expand services or stay open, since staffing, operating expenses, and other financial pressures also affect access.

More Support Is Coming for Home Dialysis Training

For patients who want dialysis at home, the 2027 rule includes an important update to training payments.

CMS is increasing the home and self-dialysis training adjustment from $95.60 to $138, reflecting the cost of preparing patients and caregivers to manage treatment outside a traditional dialysis center.

The agency is also allowing this extra training payment during the first four months of dialysis, a period when the adjustment was not previously available.

Home dialysis can provide more scheduling flexibility for eligible patients, although it still requires proper medical supervision, equipment, training, and an appropriate home setting.

Patients interested in home dialysis should discuss eligibility, training requirements, insurance coverage, and possible household expenses with their kidney care team before deciding.

Quality Standards for Dialysis Facilities Are Being Updated

The final rule also revises Medicare’s End-Stage Renal Disease Quality Incentive Program, which measures dialysis facilities against set performance standards.

Beginning with payment year 2029, CMS will replace an existing calcium-related reporting measure with a clinical measure focused on chronic hyperphosphatemia, or persistently elevated phosphorus levels in dialysis patients.

The agency is also updating how it measures bloodstream infections among hemodialysis patients by using newer national data and revised risk adjustments.

Two other reporting measures, one involving medication reconciliation and another involving healthcare personnel COVID-19 vaccination, will be removed from the quality program beginning with payment year 2029.

Although these quality changes will not affect facility payment scores immediately, they are intended to improve how Medicare evaluates dialysis care over time.

Acute Kidney Injury Dialysis Payments Are Also Changing

The new regulations also apply to dialysis treatment for patients with acute kidney injury, a condition in which kidney function suddenly declines.

Unlike end-stage renal disease, acute kidney injury may be temporary, although some patients still need dialysis while their kidneys recover.

For 2027, CMS is setting the base payment rate for acute kidney injury dialysis services at eligible dialysis facilities at $297.52, the same as the updated ESRD base rate.

The agency is also extending the home dialysis training payment changes to acute kidney injury treatment and addressing medically necessary phosphate binders for affected patients.

Patients receiving dialysis for acute kidney injury should confirm their treatment coverage and care plan directly with their medical providers and Medicare.

Will Patients Pay More Out of Pocket?

One key distinction for beneficiaries is that a higher Medicare payment to dialysis facilities does not automatically mean patients will see the same increase in their personal bills.

Under Original Medicare, covered outpatient dialysis services generally fall under Medicare Part B, which usually requires beneficiaries to pay 20% of the Medicare-approved amount after meeting the applicable deductible.

Actual costs can vary depending on the services provided, supplemental insurance, Medicare Advantage coverage, and other factors.

People enrolled in Medicare Advantage should review their plan’s dialysis cost-sharing rules and provider network rather than assuming their expenses will match Original Medicare.

For patients who receive dialysis several times a week, understanding insurance coverage and financial responsibility is especially important when planning a healthcare budget.

What Kidney Patients Should Do Before the New Rule Takes Effect

Patients already receiving dialysis do not need to assume the new Medicare payment rule means they must change facilities or treatment methods.

Still, it is a good time to review coverage details, especially for those who take phosphate binders, receive home dialysis, or have concerns about access to a nearby treatment center.

Ask your dialysis facility whether any changes to medication billing, treatment arrangements, or patient financial responsibilities are expected when the new rule begins.

Beneficiaries can also review their coverage through Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for help understanding their benefits.

Anyone considering a different Medicare plan should make sure their dialysis providers and other kidney specialists are in the new plan’s network before switching coverage.

What the 2027 Dialysis Updates Mean Overall

Medicare’s 2027 dialysis payment updates are designed to adjust reimbursements, recognize the cost of important kidney medications, and refine quality standards across dialysis facilities.

The higher base payment rate and expanded support for home dialysis training may help providers manage treatment costs, although the effect on individual patients will differ.

For older Americans living with kidney failure, the most important issues remain continued access to treatment, affordable medications, and dependable insurance coverage.

Reviewing Medicare benefits and speaking with a dialysis care team before the new year can help patients understand whether any changes will affect their care arrangements.