Does Medicare Cover 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.

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.

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.

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.

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.

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.

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.