If you are only eligible for Medicare because you have End-Stage Renal Disease (ESRD) and your condition improves, your Medicare coverage may end. Your ESRD Medicare coverage will end if:
- You no longer need dialysis. 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 to cover your immunosuppressant drug costs, you must have Medicare Part A 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 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 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.