Medicare Part A and Part B (Original Medicare) extended benefits to those suffering from end-stage renal disease (ESRD) in 1972 to help cover the high cost of medical care for those with permanent kidney failure.
Can I get Medicare if I have ESRD?
Medicare benefits are typically available to people under 65 who have been diagnosed with ESRD.
Original Medicare may cover a range of services to help treat kidney failure, including:
- Hospital inpatient dialysis
- Kidney transplants
- Outpatient dialysis from a Medicare-certified hospital or dialysis facility
- Immunosuppressant drugs after a kidney transplant (you must have had Medicare Part A at the time of transplant)
- Home dialysis training from a dialysis facility
Who is eligible for ESRD Medicare coverage?
To qualify for Medicare coverage of ESRD, you must:
- Be under the age of 65 and diagnosed with ESRD by a doctor
- Have enough work history to qualify for Social Security Disability Insurance or Social Security Retirement Benefits or enough work history to qualify for benefits through the Railroad Retirement Board
You can also qualify through the work history of your spouse or parent.
How do I enroll in Medicare if I have ESRD?
If you’re eligible for Medicare because you have ESRD, you can apply for Medicare benefits by visiting your local Social Security Office or by contacting Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
Does Medicare Advantage cover ESRD?
Medicare Advantage (Medicare Part C) plans are not typically available if you have ESRD unless you meet one or more of the following criteria:
- You are already enrolled in a Medicare Advantage plan when you are diagnosed with ESRD.
- You had ESRD but have had a successful kidney transplant, and you still qualify for Medicare benefits (based on your age or a disability). You can stay in Original Medicare, or join a Medicare Advantage Plan.
- You already get your health benefits (for example, through an employer health plan) through the same organization that offers the Medicare Advantage Plan.
If you do not qualify for a standard Medicare Advantage HMO or PPO plan, you may be eligible to enroll in a Medicare Special Needs Plan (SNP).
Medicare SNPs limit membership to people with specific diseases or financial circumstances.
Medicare Advantage SNPs tailor their benefits, provider choices and drug formularies to best meet the specific needs of the groups they serve, such as people living with ESRD.
Learn more about your Medicare coverage options
A licensed insurance agent can help you better understand your coverage options and get you enrolled in a plan that works for you.
Find a Medicare Advantage Special Needs Plan that fits your needs
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