Most people who are eligible for Medicare due to End-Stage Renal Disease (ESRD) cannot join Medicare Advantage Plans. However, there are some exceptions. These exceptions are:
- If you have ESRD, you can join a Special Needs Plan (SNP) that specifically accepts people with ESRD, if there is one in your area.
- A Special Needs Plan is a type of Medicare Advantage Plan that exclusively or primarily serves members who have a particular special need such as a chronic illness.
- If you have employer health plan coverage through the same insurance company that offers a Medicare Advantage Plan, you can enroll in that company’s Medicare Advantage Plan.
Note: If you develop ESRD after you joined a Medicare Advantage Plan, the Medicare Advantage Plan cannot disenroll you. If the plan leaves Medicare, you have a one-time Special Enrollment Period to join another plan in your area.
Remember, if you are in a Medicare Advantage Plan, you will typically have to visit doctors, hospitals and dialysis facilities that are in your plan’s network. You may have to pay for the total cost of the service if you:
- Get care outside the plan’s network or service area
- Do not ask the plan’s permission to get certain types of care or do not follow plan rules
Medicare Advantage Plans cannot charge more than Original Medicare for outpatient dialysis or immunosuppressive drugs. Medicare Advantage Plans have annual out of pocket limits on Part A and B care. These limits tend to be high but can help protect you if you have high health care costs.