Employer-based insurance is primary to Medicare for the first 30 months you are eligible for ESRD Medicare, even if you were not yet enrolled in Medicare. This is called the 30-month coordination period. This is true for both insurance based on current employment and retiree insurance. For example, if Mr. X begins dialysis at a facility in September of 2011, he is eligible for Medicare in December 1, 2011, which is the first day of the fourth month he receives dialysis. Mr. X does not enroll in Medicare until June, 2012. His 30-month coordination period still began in December, 2011 and his employer insurance will pay primary until June, 2014.

ESRD Medicare and current employer insurance

If you have current employer insurance, which is insurance from a company where you are still working, it will be your primary insurance during your 30-month coordination period. You should usually enroll in Medicare when you first qualify, even if Medicare will not be primary. This is because people with ESRD need a lot of medical care and Medicare will pay second on all claims. This means Medicare will pay for deductibles, copays and coinsurances that your employer insurance does not cover. Medicare can also place limits on the amount a provider can charge you.

Furthermore, if you need an organ transplant and have Medicare when you get the transplant, Part B will cover your immunosuppressant (anti-rejection) drugs after the 30-month coordination period ends. If you did not have Medicare at the time of your transplant, you will have to pick up a Part D plan to pay for your immunosuppressant drugs at the end of your 30-month coordination period.

ESRD Medicare and retiree insurance

If you have retiree insurance, which is insurance from a company where you used to work, it will be your primary insurance during your 30-month coordination period. You should usually enroll in Medicare when you first qualify, even if Medicare will not be primary. Please see the explanation above.

ESRD Medicare and COBRA

If you have COBRA, it will be your primary insurance during your 30-month coordination period. If you have COBRA and then enroll in Medicare, your employer can terminate COBRA, but some employers do not. If your employer terminates COBRA after you sign up for Medicare, Medicare will pay first. If you have Medicare and then qualify for COBRA, your employer must offer you COBRA. If your COBRA coverage ends before the 30 months have passed, Medicare becomes your primary insurer. If you still have COBRA when the 30-month coordination period ends, Medicare then becomes your primary insurer.

Delaying ESRD Medicare

If you have good employer insurance and you do not need Medicare to supplement your coverage, you can delay enrollment in Medicare and avoid paying the monthly Medicare Part B premium. To do so without incurring a premium penalty charge when you enroll later, you have to turn down both Part A and Part B when you first become eligible for Medicare. You should then enroll in both Part A and B just before your 30-month coordination period ends in order to avoid having any gap in coverage and paying a premium penalty. A premium penalty will apply for each 12-month period you delayed enrollment into Part B while you had Part A. If you wait to enroll in Medicare until after your 30-month coordination period, you will not be entitled to a Special Enrollment Period (SEP). You will only be allowed to enroll in Part B during certain times of year.

Be sure to talk to your employer before deciding to delay Medicare coverage. When you talk to him or her, ask how your costs will compare if you have employer coverage alone versus employer coverage and Medicare.