Medicare for End Stage Renal Disease

In Benefits Articles, Blog by eri

I recently encountered my first case of someone getting Medicare as an End Stage Renal Disease (ESRD) patient. The beneficiary had only been on SSDI for 11 months in his first period of eligibility, and I was surprised that he already had Medicare. I had heard about this possibility, but until I had to research it, I didn’t understand what it involved. Maybe this information will be useful to you at some point.

ESRD Medicare is more comprehensive coverage than regular Medicare. ESRD Medicare covers services, supplies, and treatment associated with dialysis and kidney transplants. The entitlement is not dependent on eligibility for SSDI payments. There is no age limit for ESRD Medicare, as long as a person needs regular dialysis or a kidney transplant. A person can be eligible if s/he is receiving retirement or disability payments through Social Security, Railroad Retirement or Federal government employment, or has worked enough to be eligible for these. Eligibility can also be based on being the spouse or dependent child of someone who meets these criteria.

A person typically becomes eligible for ESRD

  • the first day of the month after receiving 3 months of dialysis, or
  • the first day of hospitalization for a kidney transplant.

ESRD Medicare coverage lasts as long as dialysis continues, and for 12 months after dialysis stops. It also continues for 3 years after a successful kidney transplant. If dialysis starts again after the transplant, ESRD coverage resumes. When either of the limits are reached (12 months after dialysis stops, or 3 years after a successful kidney transplant), regular Medicare coverage will continue for people on disability benefits. If a person’s SSDI payments have stopped, any remaining months in the Extended Period of Medicare Coverage still will be available.

A person needs both Part A and Part B to receive the full range of ESRD coverage. You generally can’t be in a Medicare Advantage plan and get ESRD, but there are similar plans called Medicare Special Needs Plans that accommodate ESRD. Like Advantage plans, these are private insurance plans approved and regulated by Medicare.

More information than you will ever want about ESRD and ESRD Medicare can be found at Go to Medicare 10128 (PDF).

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