Does Medicare Cover End-Stage Renal Disease


Medicare will cover treatment for End-Stage Renal Disease. Treatment can include in-home dialysis, outpatient dialysis, and more. Yet, there are a few additional things to know about ESRD and Medicare, including the waiting period, eligibility, and plan options. For example, there are some plans for which you may not qualify due to ESRD, and other plans are made just for you.*

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Can You Get Medicare With End-Stage Renal Disease?

You can obtain Medicare coverage under age 65 if a doctor diagnoses you with End-Stage Renal Disease. However, you must have enough work history to qualify for Social Security Disability Insurance (SSDI) or be the child or spouse of someone with enough work history to qualify.*

Does Medicare Cover End-Stage Renal Disease?

Yes, Medicare covers the treatment of End-Stage Renal Disease, including dialysis and a kidney transplant. You must have permanent kidney failure requiring a kidney transplant or dialysis.*

When Does a Person Become Eligible for Medicare Due to End-Stage Renal Disease?

People who are eligible for Medicare solely due to their End-Stage Renal Disease diagnosis do not face a waiting period before they can sign up. Instead, eligibility begins when a physician prescribes a regular course of dialysis or a kidney transplant necessary for the patient to stay alive at their stage of kidney failure.*

Yet, once the patient enrolls, they may face a waiting period before their Medicare coverage begins. Typically, Medicare coverage for an eligible ESRD patient will begin on the first day of the third month following the month when they start their regular dialysis.*

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However, Medicare sometimes waives the three-month waiting period. ESRD patients eligible for Medicare may receive their coverage sooner if they:*

  • Have a kidney transplant that falls within those three months
  • Parttake in a self-dialysis training program

Do You Have to Sign Up For Medicare if You Have End-Stage Renal Disease?

Those with employer coverage don’t need to enroll in Medicare immediately. Your employer plan will cover your dialysis treatment for 30 months before Medicare automatically becomes your primary insurance. You may be able to keep your employer coverage and use it as secondary insurance to Medicare.*

If you get your insurance through the Marketplace, you sign up for Medicare if you want it. You can’t have both Medicare and Marketplace insurance. Those who don’t enroll in Medicare when their kidneys fail will have penalties when they do enroll.*

What is the 30-month Coordination Period with Medicare?

The 30-month coordination period begins on the first date you become entitled to enroll in Medicare due to End-Stage Renal Disease. During this time Medicare can be the secondary payer for 30-months.*

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The coordination period is beneficial for those with employer, COBRA, or retiree coverage. For ESRD patients without other insurance, Medicare is primary at the time of enrollment.*

Can I Enroll in Part C When I Have End-Stage Renal Disease?

Due to recent rule changes, Part C plans now cover End-Stage Renal Disease patients without restrictions. Further, Part C Special Needs Plans cater to ESRD patients.*

Can I Enroll in Medigap With End-Stage Renal Disease?

Enrolling in Medigap under 65 has more to do with state-specific rules than End-Stage Renal Disease. In many states, Medigap is just too expensive for those under 65. But, in some states, Medigap costs about the same for everyone.*

Either way, you’ll need to sign up during your Medigap Open Enrollment Period, or during a time when you have guaranteed issue rights, to avoid underwriting eligibility questions.*

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FAQs

Why Does Medicare Cover End-Stage Renal Disease?
Those with failing kidneys need dialysis or a kidney transplant to live. In the 1970s, Medicare began to cover the high cost of care for those suffering from End-Stage Renal Disease.
Is Medicare primary with ESRD?
Medicare is primary unless you’re in the first 30 months of Medicare for the condition and you have employer group coverage.
How Do I Enroll in ESRD Medicare?
Enrolling in Medicare with ESRD will require you or a family member to visit the local Social Security office. Your doctor will send forms to Social Security to verify that you have End-Stage Renal Disease and to show your treatment plan.
*

How to Find a Medicare Plan When You Have End-Stage Renal Disease

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

2 thoughts on “Does Medicare Cover End-Stage Renal Disease

  1. 3 months ago, at age 77, I signed up for B, & a Medicare advantage plan. Can I change to a Medigap? Spendy? I have no health issues of which I am aware.

    1. Hi Sandy, it is currently the Medicare Annual Enrollment Period and this timeframe will last through December 7. If you choose to, you can drop your Advantage plan, pick up a Part D prescription drug plan now, and then enroll in Medigap at any time – you’ll just have to answer health questions. There are 12 plan options and monthly premium rates vary by plan as well as by the beneficiary’s location, age, tobacco use, and other factors. Additionally, they cover the remaining 20% coinsurance for Medicare Part A and Part B, which helps beneficiaries save money in the long run.

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