You typically cannot enroll in a Medicare Advantage Plan if you are eligible for Medicare for those with End-Stage Renal Disease (ESRD Medicare). However, there are exceptions:

  • You can enroll in a Medicare Advantage Special Needs Plan (SNP) if the plan specifically serves individuals with ESRD.
    • SNPs are types of Medicare Advantage Plans designed to meet specific needs; you can only join a SNP if you fit the special needs category the plan serves.
    • SNPs are not available everywhere. Call 1-800-MEDICARE to find out if there is an SNP available in your area that serves people with ESRD.
  • If you have job-based insurance through the same insurance company that offers a Medicare Advantage Plan, you can enroll in that company’s Medicare Advantage Plan.

Note: If you enrolled in a Medicare Advantage Plan before developing ESRD, your plan cannot disenroll you. Also, if your plan leaves the Medicare program or moves out of your service area, you have a Special Enrollment Period (SEP) to enroll in another Medicare Advantage Plan in your area.

Medicare Advantage Plans must cover the same services as Original Medicare but may have different costs and restrictions. However, Medicare Advantage Plans cannot charge more than Original Medicare for outpatient dialysis or immunosuppressant drugs. In addition, Medicare Advantage Plans have annual out-of-pocket limits on your Part A and Part B care. These limits tend to be high but can help protect you if you have high health care costs.