Medicare Coverage for End Stage Renal Disease in Illinois
| Medicare Part A Coverage | Yes — hospital and inpatient care |
|---|---|
| Medicare Part B Coverage | Yes — 80% after deductible |
| Medicare Part D Coverage | Yes — prescription drugs covered |
| Your Cost Share (Part B) | 20% after $240 deductible |
| Average Annual Medicare Cost (End Stage Renal Disease) | $96,000 |
| Medicare Beneficiaries in Illinois | 2,480,000 |
Does Medicare Cover End Stage Renal Disease in Illinois?
Yes — Medicare covers end stage renal disease treatment in Illinois under both Part A (hospital/inpatient) and Part B (outpatient/physician services). The average annual Medicare cost for End Stage Renal Disease is approximately $96,000, with Medicare paying 80% of approved charges after the Part B deductible ($240 in 2026).
What Medicare Covers for End Stage Renal Disease in Illinois
- dialysis (3x/week, 100% covered after deductible)
- kidney transplant
- immunosuppressants (lifetime coverage)
- EPO injections
- home dialysis
- vascular access
- ESRD special enrollment – no 24-month wait
Your Out-of-Pocket Costs for End Stage Renal Disease in Illinois
Under Original Medicare in Illinois, you pay 20% of all Part B-covered end stage renal disease services after meeting the annual deductible ($240 in 2026). There is no out-of-pocket maximum under Original Medicare, which means costs can add up significantly for serious conditions. The average Illinois Medicare beneficiary with end stage renal disease pays approximately $19,200/year in out-of-pocket costs under Original Medicare.
Cost Comparison: Original Medicare vs. Medicare Advantage for End Stage Renal Disease in Illinois
| Coverage Type | Annual Out-of-Pocket (Estimated) | Out-of-Pocket Maximum | Prescription Coverage |
|---|---|---|---|
| Original Medicare (Parts A+B) | $19,200 | No limit | Separate Part D plan required |
| Original Medicare + Medigap Plan G | $5,040 + $1,728 Medigap premiums | Effectively capped | Separate Part D plan required |
| Medicare Advantage (avg in Illinois) | Varies by plan | Capped (varies) | Usually included |
Medicare Advantage Coverage for End Stage Renal Disease in Illinois
Medicare Advantage plans in Illinois must cover all services that Original Medicare covers for end stage renal disease, but may have different cost-sharing structures. With 58 MA plans available in Illinois, you can compare plans specifically for their end stage renal disease coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Illinois is rated 4.0 stars by CMS.
Medicare Part D Coverage for End Stage Renal Disease Medications in Illinois
Medicare Part D covers prescription drugs used to treat end stage renal disease in Illinois. In 2026, the maximum out-of-pocket cap for Part D drugs is $2100/year — a significant protection for patients with high drug costs. Illinois has 26 standalone Part D plans available. Drug coverage varies by plan formulary, so compare plans at medicare.gov/plan-compare to find the best coverage for your specific medications.
Medicaid and End Stage Renal Disease in Illinois
Illinois has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage. For dual-eligible individuals in Illinois with end stage renal disease, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.
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