If you are only eligible for Medicare because you have End-Stage Renal Disease (ESRD) End-Stage Renal Disease (ESRD) is a kidney disease that requires you to be on dialysis or have a kidney transplant. Patients with ESRD may qualify for Medicare coverage regardless of age. and your condition improves, your Medicare coverage may end. Your ESRD Medicare coverage will end if:
- You no longer need dialysis Dialysis is the treatment used to artificially cleanse your blood of toxins when your kidneys no longer work. . Your Medicare coverage will end 12 months after the month of your last dialysis treatment.
- You had a successful kidney transplant. A transplant is considered successful if it lasts for 36 months without rejection. If your transplant was successful, your Medicare coverage will end 36 months after the month of the transplant.*
Your ESRD Medicare coverage can resume if, within 12 months of stopping dialysis, you start dialysis again or have a transplant. Coverage also continues if, within 36 months of having a transplant, you start dialysis or have another transplant.
If you become eligible for ESRD Medicare again after your previous coverage ends, you can start receiving ESRD Medicare without a waiting period. Your Medicare coverage will either resume the first of the month that you start dialysis again or the first of the month you have a kidney transplant. There is also a separate 30-month coordination period each time you become eligible for ESRD Medicare.
Note: If you receive a kidney transplant and want Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. to cover your immunosuppressant drug costs, you must have Medicare Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. at the time of your transplant. If you do not have Medicare when you receive a transplant, your immunosuppressant drugs will be covered by Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. after your transplant. Part D coverage for this type of drug typically means higher costs and additional restrictions, such as having to go to specific in-network In-network means part of a private health plan’s network of providers. If you use doctors, hospitals, pharmacies, home health agencies, skilled nursing facilities, and durable medical equipment suppliers that are in your Medicare Advantage Plan or Part D plan’s network, you will generally pay less than if you go to out-of-network providers. pharmacies for your drugs.
If you have Medicare due to age or disability, your Medicare coverage will continue regardless of your ESRD Medicare status.
*If your ESRD Medicare coverage ends 36 months after your transplant and you do not have other health insurance that covers immunosuppressant medications, you may be eligible for a limited Medicare benefit called the Part B-ID benefit. The Part B-ID benefit provides Part B coverage of immunosuppressant drugs, but it does not include coverage for any other Part B benefits or services. It also does not help you access Part A. For these reasons, Part B-ID coverage may not be the best choice if you have other insurance available to you when your ESRD Medicare ends.