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Does Medicare Cover End-Stage Renal Disease


Medicare will cover treatment for those with End-Stage Renal Disease. Treatment can include in-home dialysis, outpatient dialysis, and more. But, there are some things you’ll need to know about ESRD Medicare. Such as the waiting period, eligibility, and plan options. For example, there are some plans you may not qualify for due to ESRD, and other plans are made just for you.

Can You Get Medicare With End-Stage Renal Disease

Yes, Medicare will cover you if a doctor diagnosis you with End-Stage Renal Disease. Although, you must have enough work history to qualify for Social Security Disability Insurance, or you’re the child/spouse of someone that has 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 Under ESRD

People that need dialysis aren’t eligible to enroll in Medicare until the first day of dialysis. But, hemodialysis patients will wait until the 4th month of treatment for Medicare to be effective. So, if hemodialysis begins in April, Medicare will become effective July 1. Now, for home dialysis patients, Medicare is effective in the first month of treatment.

Do You Have to Sign Up For Medicare if You Have ESRD

Those with employer coverage don’t need to enroll in Medicare immediately. Your employer plan will cover your dialysis treatment for 30 months and then Medicare automatically becomes your primary insurance. You may be able to keep your employer coverage and use it as a secondary insurance to Medicare. If your insurance is through the marketplace, you sign up for Medicare if you want it. You can’t have both Medicare and marketplace insurance. Those that don’t enroll in Medicare when kidneys fail will have penalties when you 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 ESRD. During this time Medicare can be the secondary payer for 30-months. The coordination period is beneficial for those with employer, COBRA, or retiree coverage. Now, if you don’t have other insurance, ESRD Medicare will be primary insurance when you enroll.

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

Those that already have a Part C policy when they develop ESRD can keep the plan or enroll in another plan offered by the same company. If that company leaves the service area, you have a one-time right to join another plan. Employer Medicare Advantage plans may offer you coverage.

If you’re 65 or older and have a successful kidney transplant and are determined to no longer have ESRD, you might be able to join a Part C plan. Now, some Part C Special Needs Plans will cater to ESRD patients, but those aren’t available everywhere. In 2021, Medicare Advantage plans will cover ESRD patients without restrictions.

Can I Enroll in Medigap With ESRD

Enrolling in Medigap under 65 has more to do with state-specific rules than ESRD. 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 to avoid underwriting.

FAQs

Why Does Medicare Cover End-Stage Renal Disease?
Those with failing kidneys need dialysis or a kidney transplant to live. In the 1970’s 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 ESRD Medicare and you have employer group coverage.
How Do I Enroll in ESRD Medicare?
Enrolling in ESRD Medicare 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 ESRD and to show your treatment plan.

How to Find a Medicare Plan When You Have ESRD

Finding a Medicare plan when you have a chronic disease can be a challenge. We can look at your plan options and make a recommendation based on your needs. Give us a call at the number above, and we’ll walk you through everything. If you can’t call, fill out an online rate form to see your rates now!

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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