Medicare will pay dialysis facilities a base rate of $297.52 per treatment starting January 1, 2027, up $15.81 from this year’s $281.71. The Centers for Medicare & Medicaid Services set the figure in a final rule issued October 28, and it applies to services furnished on or after the start of the year.
The number is a payment to the clinic, not a bill to the patient. That distinction decides what the increase means for dialysis patients on Medicare, and it is the part most headlines skip.
What the $297.52 base rate is
The figure is the base rate in the End-Stage Renal Disease Prospective Payment System, a bundled, per-treatment payment to dialysis facilities. CMS calls it final in its fact sheet on the calendar year 2027 rule, which states that the agency “issued a final rule to update payment rates and policies under the ESRD PPS.”
A base rate is the starting point, not the full amount a facility receives for every patient. The bundled payment is adjusted for patient characteristics, and facility-level adjustments for factors such as wage costs, rural location and low treatment volume apply on top. Two patients at the same clinic can therefore generate different payments from the same $297.52 base.
CMS built the new rate from the old one in steps. It started with $281.71, added $12.85 to reflect phosphate binders being folded into the bundled rate, applied a wage index budget neutrality factor of 1.00260 and a low-volume adjustment factor of 0.98864, then applied a 1.9% market basket update to arrive at $297.52.
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Where the extra money comes from
Not all of the $15.81 is a raise for the same services. The $12.85 for phosphate binders reflects a drug category moving into the bundle, so facilities now cover a cost that was handled separately before. The market basket update of 1.9% is the part that tracks inflation in the cost of running a facility.
CMS projects the 2027 updates will raise total payments to all dialysis facilities by 2.7% compared with 2026. The agency expects Medicare to pay $7.0 billion to approximately 7,600 facilities for renal dialysis services. Those are program-wide estimates, and the fact sheet gives no per-patient or per-clinic projection.
A change to the low-volume adjustment trims the base. The threshold rises from 4,000 to 8,000 treatments and the tiers expand from two to six, a budget-neutral change that CMS says reduces the base rate by approximately 1.1%, or about $3.
Home dialysis gets a bigger training payment
The rule also raises the add-on that pays facilities to train patients for home and self-dialysis, from $95.60 to $138.00. CMS is finalizing the add-on for the onset period as well, which covers the first four months of dialysis for a new patient, with an onset adjustment factor of 1.311.
For a retiree weighing home treatment, that matters indirectly. Training is a service the Medicare.gov page on dialysis lists as covered, and a higher payment gives facilities a stronger reason to offer it. The rule does not guarantee any clinic will expand a home program, and it says nothing about what a patient would pay for training.
The acute kidney injury rate moves in step with the base. CMS is updating the payment rate for dialysis furnished to patients with acute kidney injury to the same $297.52 for 2027, so the increase also reaches short-term dialysis that follows a sudden loss of kidney function.
What a patient actually pays
People on Original Medicare pay for outpatient dialysis through Part B. According to Medicare.gov’s dialysis coverage page, after the Part B deductible is met, a patient pays 20% of the Medicare-approved amount for dialysis in a facility. The page adds that the dollar amount of that coinsurance may vary.
The CMS fact sheet does not mention beneficiary coinsurance at all, and Medicare.gov does not tie the 20% to the $297.52 base rate. No official page converts the new facility payment into a patient dollar figure. Anyone who wants a number has to wait for the facility’s bills, which show the approved amount for each treatment.
What is on the books are the 2026 amounts. The Medicare.gov costs page lists a 2026 Part B premium of $202.90 a month and a 2026 deductible of $283. It lists no 2027 figures, so the Part B premium and deductible for next year are still unpublished and the full cost picture for 2027 is open.
What dialysis patients can do with this now
Patients who see the headline rate and assume a bigger or smaller bill are guessing. The base payment is the clinic’s revenue formula. The patient’s share depends on the approved amount, the deductible status in a given month, and any supplemental coverage such as a Medigap policy or Medicaid that picks up some of the 20%.
The practical step is to watch the Medicare Summary Notice and the facility’s statements after January 1, because they show the approved amount for each treatment and the coinsurance that follows from it. A change from December’s statements to January’s is the first real sign of what the rule did to a particular patient.
Medicare.gov describes the Part B deductible as an amount paid once a year before Original Medicare starts to pay. Patients without supplemental coverage will see it on their statements as they meet it, ahead of the 20% share.
Will a dialysis patient’s share of the bill change in 2027?
The detail that gets missed is that the $297.52 is the clinic’s payment and the 20% coinsurance is what lands on the patient. Nothing published so far connects the two, and the 2027 Part B premium and deductible have not been published, so a dialysis household cannot yet price next year.
Cut Your Medicare Bill is an 11-page guide with Medicare bill review steps and a plain explanation of what the 20 percent coinsurance covers, so a Medicare Summary Notice is easier to follow line by line. It also covers the surcharge appeal with Form SSA-44 for people whose income dropped after retirement.
A one-table summary of 2026 Medicare costs sits at the front, which gives a reader a baseline to compare against when the 2027 figures arrive.
Get the bill review steps and 20 percent coinsurance explainer in Cut Your Medicare Bill →
This article was produced with AI assistance and edited for accuracy against the sources linked above.
