It’s easy to be overwhelmed by Medicare. From the terms to the options to consider to the everchanging benefits, it can be a lot to take in. Here’s a guide to help you navigate Medicare coverage with end-stage renal disease (ESRD).
End-Stage Renal Disease and Medicare Eligibility Requirements
Individuals with ESRD, including those under 65, are eligible to enroll in Original Medicare at any time. As of January 1, 2021, those with ESRD can also enroll in Medicare Advantage plans, which increases options for chronic-disease management and potentially more flexible or affordable payment opportunities.
Medicare Coverage for End-Stage Renal Disease
Original Medicare, Part A and Part B, cover many treatments and medications needed to treat ESRD. Medicare can also cover costs for preventative care and a portion of the costs for other conditions you may have.
Original Medicare (Part A and B) Coverage
Part A—also known as Medicare hospital insurance—provides coverage for things such as inpatient dialysis treatments, cost of care for a kidney donor and in-patient hospital care. Part B—also known as medical insurance—will provide coverage for things like outpatient dialysis treatments, at-home dialysis, home dialysis training, equipment, supplies and more.
Medicare Part C (Medicare Advantage Plan) Coverage
If you have a Medicare Advantage plan, also known as Part C, it will cover at least everything that Original Medicare covers. Medicare Advantage plans, however, also offer additional coverages, which could include prescription medications that are not covered by Original Medicare.
Medicare Part D (Prescription Drug Plan) Coverage
Medicare Part D, also known as Medicare Prescription Drug Plans, help cover the cost of prescription medications that may not be covered under Original Medicare. Not all Medicare Part D plans cover the same medications but provide a standard level of coverage established by Medicare.
Medicare Supplement Plan Coverage
Medicare Supplement plans, also known as Medigap, help cover gaps in coverage from Medicare Part A and Part B. Medicare Supplement plans can help pay for out-of-pocket costs like deductibles, coinsurance and copayments.
How-To Apply for Medicare Coverage if You Have ESRD
You are eligible to receive Medicare disability coverage if you are disabled—regardless of age—and qualify for Social Security disability insurance. If you have ESRD, you’ll have to enroll in all parts of Medicare manually through Social Security’s website. Medicare coverage can begin as soon as the first day after three months following a course of regular dialysis or kidney transplant. Under certain conditions, Medicare could start on the first month of dialysis.
In what ways can Medicare interact with my current employer or union group health plan?
If you have a health plan from an employer or union group along with Medicare coverage, each type of coverage is considered a “payer.” The coordination of benefits rules decide which type of coverage pays first. The “primary payer” will pay up to the limits of its coverage, and the rest is sent to the “secondary payer.”1
SelectQuote Can Help Those with End-Stage Renal Disease Find the Right Medicare Plan for Them
Medicare can seem confusing as is, but for individuals with ESRD, it can be even harder to understand what type of coverage is right for you. We can help you through the process of finding Medicare coverage, answering any questions you may have about Medicare eligibility or coverage for treatment of ESRD. We’ll make sure you have the coverage you need and the benefits available to you.
1https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance
