Medicare News
Medicare Coverage of End-Stage Renal Disease (ESRD)

We Will Call You

Fill out some basic information and one of our Licensed Sales Agents/Producers will contact you.

Medicare Coverage of End-Stage Renal Disease (ESRD)

Monday, February 26, 2018 12:40 PM

 Medicare Coverage of End-Stage Renal Disease (ESRD)

Americans of all ages, even those under the age of 65, with End-Stage Renal Disease (ESRD) may be eligible to receive Medicare benefits through the Medicare End-Stage Renal Disease Program. Learn more about ESRD and Medicare coverage options below.

What is End-Stage Renal Disease (ESRD)?

According to the U.S. Renal Data System Annual Data Report, chronic kidney failure, also called end-stage renal disease, or ESRD ("renal" is another word for kidney), affects almost 650,000 people per year in the United States. Often progressing slowly over a period of years, kidney failure is measured in five stages - and ESRD is the final stage when kidneys no longer function on their own. The job of healthy kidneys is to filter waste and fluids from building up in the body. However, when kidneys fail, patients must undergo lifelong dialysis treatments to replace the kidney’s filtering function. The other choice for an ESRD patient, if eligible, is a kidney transplant, which requires a donor match, major surgery, and a lifetime of medications to prevent rejection.

ESRD and Original Medicare coverage

ESRD Medicare recipients can qualify for health care coverage through Original Medicare (Part A and B) if: 

  • Their kidneys no longer work
  • Regular dialysis is needed, or they’ve had a kidney transplant
  • One of the following apply:
    • They’ve worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
    • They’re already getting or are eligible for Social Security or Railroad Retirement benefits
    • They’re the spouse or dependent child of a person who meets either of the requirements listed above

Does Medicare cover kidney dialysis?

Medicare Part A (Hospital Insurance) may cover or pay part of the costs for inpatient dialysis treatments at a Medicare-approved hospital.

Medicare Part B (Medical Insurance) may cover part of the costs for certain self-dialysis drugs, a variety of equipment, supplies, and services, including self-dialysis support services and training from a Medicare-certified dialysis facility.

Does Medicare cover a kidney transplant?

Medicare Part A (Hospital Insurance) may cover or pay part of the costs for transplant services in a Medicare-approved hospital for inpatient services, blood, lab tests, the kidney registry fee, and kidney donor-related costs.

Medicare Part B (Medical Insurance) may cover part of the costs for doctor’s services that accept assignment for kidney transplant surgery, a limited period of transplant drugs, and blood.

Please note: This is not a complete list of coverage. Contact your Medicare provider or visit Medicare.gov for specific information about tests, items, or services covered by your health insurance plan.

ESRD and Medicare Advantage Plans 

Generally, ESRD Medicare recipients can only enroll in a Medicare Advantage Plan (MA) under the following circumstances:

  • They are already in a Medicare Advantage Plan when they develop ESRD
  • They are already getting health benefits (e.g., through an employer health plan) through the same organization that offers the Medicare Advantage Plan
  • They had ESRD, but have had a successful kidney transplant, and still qualify for Medicare benefits (based on age or a disability)

ESRD Medicare recipients may qualify for a Medicare Special Needs Plan (SNP), a type of Medicare Advantage Plan (like an HMO or PPO), if one is available in their area.

ESRD and Prescription Drug Plans

Original Medicare (Part A and Part B) does not cover prescription drugs. Therefore, ESRD Medicare recipients needing prescription drug coverage must join a plan run by a private insurance company approved by Medicare. ESRD Medicare recipients can generally enroll in a stand-alone Medicare Prescription Drug Plan (PDP) that may cover prescription drugs. They may also qualify for a Medicare Special Needs Plan (SNP), a type of Medicare Advantage Plan, that provides prescription drug coverage (MA-PD).

ESRD and Medigap

The Medicare program helps with the cost of health care for ESRD patients, but it doesn’t cover all medical expenses or the cost of most long-term care. Purchasing a Medicare Supplement Plan (Medigap), sold by private companies, can help pay for some of the health care costs that Original Medicare doesn't cover, including copayments, coinsurance, and deductibles. However, ESRD Medicare recipients can only buy a Medigap plan, if it’s available in their state. Federal law does not require all states to sell to people under 65 with ESRD.

To find out if Medigap is available in your state, compare Prescription Drug Plans, and learn more about eligibility for Medicare Advantage Plans, contact one of our experienced, licensed sales agents at (888) 815-3313 – TTY 711.

Related Information:

Compare Medicare Supplement Plans F and G

5 Best Pill Reminder Apps

 

 

 

 

 

MULTIPLAN_GHHK3T9EN_Accepted

Medicare.org is a non-government site and is operated by HealthCompare Insurance Services, a licensed health insurance agency certified to sell Medicare products. It contains information about and access to insurance plans for Medicare beneficiaries, individuals soon eligible for Medicare and those advising on behalf of Medicare beneficiaries. Medicare.org is not endorsed by the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.

If you're looking for the government's Medicare site, please navigate to www.medicare.gov.

HealthCompare Insurance Services, Inc. is a licensed and certified representative of Medicare Advantage HMO, PPO and PFFS organizations and Medicare Prescription Drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1, of each year.

The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click on the carrier’s link below.

Aetna
Anthem
Blue Cross Blue Shield - Illinois
Blue Cross Blue Shield - Montana
Blue Cross Blue Shield - New Mexico
Blue Cross Blue Shield - Oklahoma
Blue Cross Blue Shield - Texas
Blue Shield of California
Capital Blue Cross
Cigna Health Spring
Global Health
Highmark
Humana
Humana
Premera Blue Cross
SCAN
Scott & White
United HealthCare
Vibra Health Plan

Last Revised 11/15/2017