ESRD and Your Medicare Options: What You Should Know

ESRD and Your Medicare Options: What You Should Know

End-Stage Renal Disease (ESRD), is permanent kidney failure requiring dialysis or a kidney transplant. Any individual who has ESRD, regardless of age, is eligible for Medicare. If your kidneys no longer work, you require dialysis or have had a kidney transplant, and if you’ve worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee (or you’re the spouse or dependent child of someone who has met these qualifications), you will qualify for Medicare coverage.

When you enroll in Medicare Part A due to ESRD, you will have the choice to enroll in Part B, as well. Enrolling in Part B will allow you to receive the full Medicare benefits available to individuals with ESRD, but you must pay a monthly premium to get Part B, and your costs may vary depending on your coverage and the services you use.

If you have ESRD and Original Medicare, you may want to join a Medicare Prescription Drug Plan (PDP) to help cover the costs of your prescription drugs. If you have ESRD and would like to consider buying a Medigap policy, note that not all insurance companies will sell Medigap policies to people with Medicare under 65. You should contact your State Health Insurance Assistance Program for more information.

If you have ESRD, you can enroll in a Medicare Advantage (MA) plan during Medicare’s Annual Election Period (AEP) from October 15 through December 7. Coverage would go into effect on January 1. Medicare Advantage plans are offered by private insurance companies as an alternative to Original Medicare. MA plans are required to provide the same Part A and Part B benefits as Original Medicare, but many offer additional benefits, such as vision and dental care, fitness programs, and prescription drug coverage.