Medicare is changing how much it pays dialysis facilities in 2027, with new rules affecting treatment reimbursements, medications, and quality standards for Americans living with kidney failure.
The Centers for Medicare & Medicaid Services (CMS) announced that its updated dialysis payment rate will increase to $297.52 per treatment, up from $281.71 in 2026. The agency estimates the changes will increase total Medicare payments to dialysis facilities by approximately 2.7%.
The final rule, issued October 28, 2026, takes effect January 1, 2027, and includes changes affecting medications, smaller dialysis facilities, home dialysis training, and quality reporting.
For Medicare beneficiaries receiving dialysis, understanding these changes can help them ask better questions about their treatment options, coverage, and potential out-of-pocket expenses.
Medicare Dialysis Payment Rates Are Increasing in 2027
The biggest financial change involves Medicare’s End-Stage Renal Disease Prospective Payment System, which determines how dialysis facilities are reimbursed for treating patients with permanent kidney failure.
Under the new rule, the base payment rate increases by $15.81 per treatment, from $281.71 in 2026 to $297.52 in 2027.
According to CMS, Medicare expects to spend approximately $7 billion on dialysis services provided by roughly 7,600 facilities during 2027.
The payment system bundles dialysis treatment and many related services into a single reimbursement amount, with adjustments based on patient characteristics, geographic costs, and other factors.
Importantly, the $297.52 figure represents a Medicare payment base rate, not the amount every patient will pay for treatment.
Kidney Medications Are Being Incorporated Into Dialysis Payments
Another important change involves phosphate binders, medications commonly prescribed to patients with kidney failure to help control phosphorus levels in their blood.
Beginning in 2027, CMS is permanently incorporating the costs of these medications into the standard dialysis payment rate, adding $12.85 to the base amount.
High phosphorus levels can contribute to serious health complications, including bone and cardiovascular problems, making phosphate management an important part of kidney care.
The change completes a transition that began in January 2025, when Medicare started incorporating phosphate binders into its dialysis payment system.
Patients should ask their dialysis providers how their phosphate binder medications will be supplied and billed in 2027, particularly if they currently obtain them through a separate pharmacy.
Smaller Dialysis Facilities Will Receive Updated Payment Adjustments
Medicare is also changing how it compensates smaller dialysis facilities, which can face higher operating costs because they treat fewer patients.
The new rule increases the eligibility threshold for the Low-Volume Payment Adjustment from 4,000 to 8,000 dialysis treatments annually.
CMS is also expanding the payment adjustment structure from two tiers to six, allowing reimbursement to reflect differences in facility size more precisely.
These changes could be particularly relevant to patients who depend on smaller dialysis centers, including those in rural communities where treatment alternatives may be limited.
However, the new payment structure does not guarantee that individual facilities will expand services or remain open, since staffing, operating expenses, and other financial factors also influence access.
Medicare Is Increasing Support for Home Dialysis Training
For patients who prefer receiving dialysis at home, the 2027 rule includes a potentially important change to training reimbursements.
CMS is increasing the home and self-dialysis training payment adjustment from $95.60 to $138, reflecting the costs of preparing patients and caregivers to manage treatment outside a traditional dialysis facility.
The agency is also allowing this additional training payment during the first four months of dialysis, a period when the adjustment was previously unavailable.
Home dialysis can offer greater scheduling flexibility for eligible patients, although it requires appropriate medical supervision, equipment, training, and a suitable home environment.
Patients interested in home dialysis should discuss their eligibility, training needs, insurance coverage, and potential household expenses with their kidney care team before making a decision.
New Quality Standards Will Affect Dialysis Facilities
The final rule also updates Medicare’s End-Stage Renal Disease Quality Incentive Program, which evaluates dialysis facilities using established performance measures.
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 evaluates bloodstream infections among hemodialysis patients, using newer national data and revised risk adjustments.
Two additional reporting measures involving medication reconciliation and healthcare personnel COVID-19 vaccination will be removed from the quality program beginning with payment year 2029.
Although these particular quality measurement changes will not affect facility payment scores immediately in January 2027, they are intended to refine how Medicare evaluates dialysis care over time.
Acute Kidney Injury Dialysis Payments Are Changing, Too
The new regulations also affect dialysis treatment for patients experiencing acute kidney injury, a condition in which kidney function declines suddenly.
Unlike end-stage renal disease, acute kidney injury may be temporary, although some patients require dialysis while their kidneys recover.
For 2027, CMS is setting the base payment rate for acute kidney injury dialysis services provided at eligible dialysis facilities at $297.52, matching the updated ESRD payment base rate.
The agency is also extending relevant 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 Medicare Patients Pay More for Dialysis in 2027?
One of the most important distinctions for beneficiaries is that an increase in Medicare’s payment to dialysis facilities does not automatically mean patients will face the same increase in their personal medical bills.
Under Original Medicare, covered outpatient dialysis services generally fall under Medicare Part B, which typically requires beneficiaries to pay 20% of the Medicare-approved amount after meeting the applicable deductible.
However, actual patient expenses can depend on the services provided, supplemental insurance, Medicare Advantage coverage, and other circumstances.
Beneficiaries enrolled in Medicare Advantage should review their plan’s dialysis cost-sharing requirements and provider network rather than assuming their costs will match Original Medicare.
For patients who receive dialysis several times a week, understanding their insurance coverage and financial responsibilities is especially important when preparing a healthcare budget.
What Kidney Patients Should Do Before January 2027
Patients receiving ongoing dialysis do not need to assume that the new Medicare payment rule requires them to change facilities or treatment methods.
However, it is a good opportunity to review coverage details, particularly if they 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 in January.
Beneficiaries can also review their coverage through Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for assistance understanding their benefits.
Anyone considering a different Medicare plan should verify that their dialysis providers and other kidney specialists participate in the new plan’s network before switching coverage.
What the 2027 Dialysis Changes Mean for Your Healthcare
Medicare’s 2027 dialysis payment updates are designed to adjust reimbursements, recognize the costs 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 facilities manage the costs of providing treatment, although the financial impact on individual patients will vary.
For older Americans managing kidney failure, the most important questions involve continued access to treatment, affordable medications, and reliable insurance coverage.
Reviewing your Medicare benefits and speaking with your dialysis care team before the new year can help you understand whether any changes will affect your treatment arrangements.
Do you or someone in your family receive dialysis through Medicare? Have you experienced changes in treatment costs, medication coverage, or access to dialysis facilities? Share your experiences in the comments.
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Amanda Blankenship is Chief Editor at District Media, Inc., leading content strategy, quality assurance, and editorial operations across high-traffic personal finance sites like SavingAdvice.com and CleverDude.com. A Wingate University graduate with a BA in Communications (Journalism focus), she brings over a decade of experience in digital publishing, writing, and team leadership in the personal finance space.
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