Medicare and End Stage Renal Disease

How do Medicare and End Stage Renal Disease fit together?

If you or a loved one has recently been diagnosed with end stage renal disease (ESRD), then you are probably asking yourself “Are people with end stage renal disease covered by Medicare?”

As difficult as this diagnosis is, you might at least take some comfort in the fact that Medicare does, in fact, cover a range of services related to the treatment and management of ESRD. In addition, when you become eligible for Medicare as a result of an ESRD diagnosis (regardless of your age), you will also have access to all of the usual services that Medicare coverage provides.

At MedicareInsurance.com, we’re here to help you learn more about Medicare coverage in this situation. Let’s start by gaining a basic understanding of what end stage renal disease is.

What is end stage renal disease?

End stage renal disease (ESRD), also known as end stage kidney failure, or simply, kidney failure, is a life-threatening condition that occurs when chronic kidney disease and the gradual loss of kidney function reaches an advanced state. This means that one’s kidneys are no longer properly filtering waste and excessive fluids from your blood.

During ESRD, you will need dialysis or a kidney transplant to stay alive. In addition, patients with this condition are encouraged to seek conservative levels of care to help manage their symptoms in an effort to maintain the best possible quality of life. ESRD Medicare is intended to help you cover the costs of these treatments and services.

When can I achieve ESRD Medicare eligibility?

Unlike the usual case, you can become eligible for Medicare as a result of ESRD before you reach the age of 65. In fact, being under the age of 65 is a requirement for ESRD Medicare, as is having been formally diagnosed with ESRD by a doctor.

In addition to these requirements, you must also have worked long enough to qualify for Social Security Disability Insurance (SSDI) or Social Security retirement benefits, or possess enough railroad work history to qualify for Railroad Retirement benefits or railroad disability annuity. If your spouse or parent has enough work history, you may also qualify.

To ensure that you have enough work history to qualify for Medicare Part B end stage renal disease eligibility, you can contact the Social Security Administration directly at (800) 772-1213.

When can I enroll in ESRD Medicare?

As stated, Social Security is primarily responsible for determining your ESRD Medicare eligibility (even if you qualify based on prior railroad work). Typically, you can enroll in Medicare after your doctor or healthcare provider sends official documentation to Social Security in order to verify your diagnosis and confirm that you are about to begin your treatment.

In the event that you are unable to enroll in ESRD Medicare by yourself due to your illness, an authorized family member or other designated priority can handle the paperwork associated with Medicare and end stage renal disease enrollment. 

The time frame during which your ESRD Medicare officially begins will depend on your specific treatment plan. 

For example, if you begin home dialysis, you will be eligible for Medicare beginning on the first day of the first month of self-dialysis treatment. On the other hand, if you receive dialysis at an inpatient or outpatient facility, your ESRD Medicare can begin starting the first day of the fourth month of your treatment.

Finally, if you are approved to undergo a kidney transplant, your Medicare coverage will begin starting in the month in which you are first admitted to a Medicare-approved hospital in preparation for the surgery. However, you must receive the transplant within two months following the beginning of your coverage. If the transplant is delayed, Medicare coverage begins two months before the month of your transplant.

It’s no secret that end stage renal disease is a serious, life-threatening condition. But with ESRD Medicare, it is at least possible to receive the coverage you will need to help you and your family pay for the cost of your treatment.

To learn more about how Medicare and end stage renal disease coexist, click here.