Dialysis

The choice is not which clinic. It is whether she goes at all.

Almost everyone starts dialysis the same way: three sessions a week, about four hours in the chair, at a unit. Medicare's own description of the usual course is "3 hemodialysis (or equivalent peritoneal dialysis) treatments each week". Nobody sits a family down and explains that "or equivalent peritoneal dialysis" is a fork with a completely different shape of week on the other side of it.

Neither column is the right answer. Home dialysis asks a great deal of a household that may already be stretched, and it needs somebody able to learn a procedure and keep doing it. The point is that it is a question with two arms, and a family who never hears it asked has already answered it.

The transport problem, which is the real reason this page exists

Three round trips a week is 156 a year. For an older person who no longer drives, that number is the single biggest logistical fact of her life, and it usually lands on an adult child or a spouse.

Here is the part families discover late: Medicare will not pay for the ride. Part B covers ambulance transport to and from the nearest dialysis facility only when traveling in any other vehicle would endanger her health. A taxi to a routine appointment is not covered, and neither is a paid aide to help with home dialysis, or a place to stay near the unit during treatment.

That leaves three real answers, and two of them are free or nearly so:

• Medicaid non-emergency medical transport. If she has Medicaid, rides to covered medical appointments are a benefit the state must provide. This is the biggest single answer and it is routinely unused.
• Your county's volunteer driver program or paratransit. Free or a couple of dollars a ride in most Oregon counties, and almost nobody knows they exist.
• The unit's own arrangement. Ask what other patients do. Some units know a service; some coordinate car-pooling; some do nothing and will say so.

How each of those works, and who to call — it is a whole area of this site, and dialysis is the reason most families reach it.

What it costs

After the Part B deductible, Original Medicare pays 80% and she pays 20% of the Medicare-approved amount — for treatment at a facility and for treatment at home alike. On a treatment schedule that runs indefinitely, a 20% coinsurance with no annual cap is the reason Medigap or a Medicare Advantage plan matters more here than almost anywhere else. Read the plan materials, or call the benefits administrator, before assuming.

Medicare covers the home training itself, for her and for the person helping her — but not lost pay for either of them while they train, which is a real cost for a working daughter and is worth planning for rather than discovering.

What to ask a unit

• What shifts do you run, and what is actually open? A unit with a late shift is a different life for a family that works. Availability is the constraint, not preference.
• Do you train for home dialysis, and if not, who nearby does? Only 18 facilities in Oregon train for home hemodialysis, across 12 counties.
• What happens when she is admitted to hospital? Ask who coordinates, and whether her chair is held.
• What do your patients do about getting here? The most useful question on the list, and the one nobody asks.

Coverage, the 20% coinsurance, the ambulance rule and the list of what Medicare does not cover read 2026-08-16 from Medicare's dialysis coverage page. Facility counts, the modalities each offers and the station counts are from the CMS Dialysis Facility Listing, Oregon rows, read 2026-08-16 — 69 certified facilities across 25 counties. Four of them publish a station count of zero, which means a unit that trains and supports home dialysis rather than one with an empty floor.