You can enroll in Medicare based on End-Stage Renal Disease (ESRD) at the same time you are enrolled in Medicare based on disability or age. Whether or not you need to enroll into ESRD Medicare at the same time you are enrolled in Medicare based on age or disability depends on which you had first.

If you have Medicare based on ESRD first, you should also enroll in Medicare when you qualify for it on another basis. This is because ESRD Medicare may end after a successful kidney transplant, but you still want to have Medicare to cover your immunosuppressants and other health care needs.

However, if you qualify for Medicare based on age/disability you usually will not need ESRD Medicare. There are some exceptions.

If you have Medicare based on age first, you do not need Medicare based on ESRD unless:

  • You need an earlier Medicare start date because Medicare based on ESRD can be retroactive up to one year.
  • You declined Part B during your Initial Enrollment Period and want to have Part B right away and to avoid late enrollment penalties.
  • You already have Part B but pay a premium penalty because you enrolled late. Enrolling in Medicare Part B based on ESRD will remove the premium penalty.

If you qualify for Medicare based on disability first, you may want to enroll in Medicare based on ESRD if:

You are still within your 24-month waiting period for Medicare based on disability because Medicare for ESRD will start earlier than your Medicare based on your disability will.

  • You declined Part B during your Initial Enrollment Period and want to have Part B right away and to avoid late enrollment penalties.

Coordination of benefits:

If you have ESRD Medicare first before you become eligible for age/disability Medicare, all  employer benefits (current employer, retiree, and COBRA insurance) pay first during the 30-month coordination period. After the 30-month coordination period, Medicare pays first.

If you have Medicare due to age/disability and are diagnosed with End-Stage Renal Disease, you will most likely not have to take ESRD Medicare. However, if you do need to take ESRD Medicare for one of the reasons listed above, coordination of benefits will work as it does for people with age/disability related Medicare. This means that insurance from a former employer (COBRA or retiree insurance) will pay second and Medicare will pay first. If you have insurance from a current employer, whether Medicare pays first or second depends on the size of the employer.