I have ESRD. Am I eligible for Medicare?
You can get Medicare no matter how old you are if all of these apply:
- Your kidneys no longer work
- You need regular dialysis or have had a kidney transplant
- One of these applies to you:
- You've worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
- You’re already getting or are eligible for Social Security or Railroad Retirement benefits
- You’re the spouse or dependent child of a person who meets either of the requirements listed above
Contact Social Security for more information about the amount of time required to be eligible for Medicare. If you get benefits from the Railroad Retirement Board (RRB), contact the Railroad Retirement Board.
I’m on kidney dialysis or am a kidney transplant patient. How do I sign up for Part A and Part B?
If you’re eligible for Medicare because of ESRD, you can enroll in Part A and Part B by visiting your local Social Security office or by contacting Social Security.
If you qualify for Part A, you can also get Part B. Enrolling in Medicare is your choice. But, you’ll need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services.
If I enroll in Medicare because of ESRD, when does my Medicare coverage start?
When you enroll in Medicare based on ESRD and you’re on dialysis, Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. This waiting period will start even if you haven’t signed up for Medicare. For example, if you don’t sign up until after you’ve met all the requirements, your coverage could begin up to 12 months before the month you apply.
If you're covered by an employer group health plan, your Medicare coverage will still start the fourth month of dialysis treatments. Your employer group may pay the first 3 months of dialysis.
Medicare coverage can begin the first month of a regular course of dialysis treatments if you meet both of these conditions:
- You participate in a home dialysis training program offered by a Medicare-approved training facility during the first 3 months of your regular course of dialysis.
- Your doctor expects you to finish training and be able to do your own dialysis treatments.
Important: Medicare won’t cover surgery or other services needed to prepare for dialysis (like surgery for a blood access (fistula)) before Medicare coverage begins. However, if you complete home dialysis training, your Medicare coverage will start the month you begin regular dialysis, and these services could be covered.
If you’re already getting Medicare due to age or disability, Medicare will cover physician-ordered fistula placement or other preparatory services before dialysis begins.
When will my Medicare coverage end because I have ESRD?
If you have Medicare only because of permanent kidney failure, Medicare coverage will end:
- 12 months after the month you stop dialysis treatments.
- 36 months after the month you have a kidney transplant.
Your Medicare coverage will be extended if:
- You start dialysis again, or you get a kidney transplant within 12 months after the month you stopped getting dialysis.
- You start dialysis or get another kidney transplant within 36 months after the month you get a kidney transplant.
If you qualify for Part A, you can also get Part B. Enrolling in Part B is your choice. But, you’ll need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services.
I’m over 65 (or disabled) and only have Part A. Now that I have ESRD, can I sign up for Part B?
I’m over 65 (or disabled). I’m paying a late enrollment penalty because I didn’t enroll in Part B when I was first eligible. Now that I have ESRD, do I need to continue to pay the higher Part B premium?
I have ESRD, but I haven’t signed up for Medicare. Can I get a plan through the Health Insurance Marketplace?
Yes. People with ESRD aren’t required to sign up for Medicare. If you have ESRD and don’t have either Medicare Part A or Part B, you can get a Marketplace plan. You may also be eligible for tax credits and reduced cost-sharing through the Marketplace.
I have Medicare coverage due to ESRD. Can I drop my Medicare coverage and choose a Marketplace plan?
Generally, no. Once you apply for Medicare, your Medicare coverage will end one year after you stop getting regular dialysis or 36 months after a successful kidney transplant. However, you may withdraw your original Medicare application. You would have to repay all costs covered by Medicare, pay any outstanding balances, and refund any benefits you got from Social Security or the Railroad Retirement Board. Once you’ve made all of the repayments, the withdrawal will be processed as though you never had Medicare at all.