When your kidneys are no longer able to function properly, dialysis may provide the solution you need to meet your body’s needs. Kidneys are responsible for removing waste products and excess fluid from the body and releasing hormones that regulate blood pressure. They are referred to as “powerful chemical factories” by the National Kidney Foundation and perform a “life sustaining job.” When the kidneys permanently fail, dialysis can keep you alive.
When chronic kidney disease has reached an advanced stage and you are diagnosed with End-Stage Renal Disease (ESRD), you will qualify for Medicare regardless of your age as long as you:
- Have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee
- You are eligible for or already receiving benefits from Social Security or the Railroad Retirement Board
- You are the spouse or dependent child of someone who meets the criteria
If you are diagnosed with ESRD, Medicare will cover kidney dialysis services and supplies. Your coverage usually starts on the first day of your fourth month of dialysis. Most people who qualify for Medicare based on ESRD receive their benefits from Original Medicare, the federal program that administers Part A (Hospital Insurance) and Part B (Medical Insurance). Some people with ESRD may enroll in a Medicare Advantage Special Needs Plan (SNP) if one is available in your area. Medicare Advantage plans are required to provide the same coverage as Original Medicare, but many provide additional benefits.
Medicare Can Help Pay for Dialysis
Medicare Part A will cover dialysis treatments if you are in a Medicare-approved hospital and have been officially admitted. Medicare Part B will cover outpatient dialysis treatments, including supplies, drugs, and biologicals, that you receive regularly in a Medicare-approved dialysis facility. If you are eligible for self-dialysis, Part B will help cover the cost of training, equipment, supplies, and support services. You will likely pay 20% of the Medicare-approved amount of dialysis treatments, and the Part B deductible applies.
Some Medicare recipients with Original Medicare choose to enroll in supplemental insurance to help pay their out-of-pocket expenses. A Medigap, or Medicare Supplement, policy will help cover deductibles, coinsurance and copayments. People with ESRD may have to wait until they are 65 years of age to purchase a Medigap policy. You will have a six-month Medigap Open Enrollment Period after you turn 65 and are enrolled in Part B. During this initial enrollment period, you will have a guaranteed issue right to purchase any Medigap policy available in your state without being subject to medical underwriting. You will not be excluded or charged more based on a pre-existing condition during this period of time.