End-stage renal disease (ESRD) is the final point of chronic kidney disease, aka kidney failure. In ESRD, your kidneys no longer function the way they should to meet the needs of your body. Diabetes and high blood pressure are the most common causes of ESRD in the U.S. These conditions can hurt your kidneys.
Medicare will cover treatment for people with ESRD, even if they’re under 65. Let’s talk more about kidney function, Medicare, and end-stage renal disease.
What Do Kidneys Do?
Your kidneys do many things each day to maintain your health, including:
- Controlling acid levels
- Controlling blood pressure
- Removing waste and extra fluid
- Making red blood cells — that give you energy
- Making vitamin D — so you can absorb calcium
What ESRD Treatment Does Medicare Cover?
Medicare covers ESRD treatment, including dialysis and a kidney transplant. A person must have permanent kidney failure requiring these treatments.
What Is Dialysis?
It’s the process of ridding the body of excess fluids, waste products, and unwanted toxins by filtering the blood — when the kidneys stop doing their job. Hemodialysis and peritoneal dialysis are two common kinds of dialysis.
Medicare Eligibility Under ESRD
As mentioned, you CAN get Medicare with ESRD. However, you must have the work history to qualify for Social Security Disability Insurance, or you’re the child/spouse of a person that has good work history to qualify.
You’re eligible to sign up for Medicare on the first day of dialysis. Hemodialysis patients wait until the fourth month of treatment for Medicare to take effect. Currently, for home dialysis patients, Medicare takes effect during the first month of treatment.
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How it Works with Employer Coverage
If you have ESRD and employer coverage, you don’t need to sign up for Medicare right away. Your employer plan will pay for dialysis treatment for 30 months. Then, Medicare will become your primary insurance. You might be able to keep your employer plan and use it as secondary coverage.
Note: People who don’t enroll in Medicare when their kidneys fail will face penalties when signing up.
The 30-Month Coordination Period
The coordination period helps people with employer, retiree, or COBRA coverage. It starts on the first day you become entitled to sign up for Medicare because of ESRD. During this period, Medicare can be the secondary insurance for 30 months. If you don’t have other coverage, ESRD Medicare will act as the primary insurance when you sign up.
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Can You Enroll in Part C with ESRD?
People who already have an Advantage (Part C) plan when they develop the disease can keep it or enroll in a different plan offered by the same carrier. If that carrier leaves the service area, you get a one-time right to join another program. Employer Advantage plans may also provide coverage.
You may be able to join an Advantage plan if you’re 65 or older and undergo a successful kidney transplant — and you no longer have the disease. Some Advantage plans are tailored to ESRD patients, but these are available in certain areas. In 2021, Advantage plans will cover ESRD patients with no limits.
Medigap and ESRD
You can enroll in Medigap under 65, but it relates more to state-specific requirements than ESRD. In some states, Medigap costs too much for people under 65. In other states, Medigap insurance costs roughly the same for everybody. No matter your location, it’s best to enroll during your Medigap Open Enrollment Period to avoid medical underwriting.
We Can Help You Find a Suitable Medicare Plan
It can be tough to find a Medicare plan when you have a chronic disease. That’s why you should work with an insurance agent at Trusted Senior Specialists. We’ll examine your options and make a suggestion based on your specific needs. Call (855) 952-1941, and we’ll walk you through the process.
