Medicare Reminders: ESRD

 

Two things to remember about Medicare and End-Stage Renal Disease (ESRD)

If you have been diagnosed with End-Stage Renal Disease (ESRD) and are getting dialysis treatments or have had a kidney transplant, you are eligible for Medicare. Enrollment depends on your condition.

When your condition improves, your Medicare coverage may end.

It will end if:

• You no longer need dialysis. Your Medicare coverage will end 12 months after the month in which you had your last dialysis treatment.
• You had a successful kidney transplant. A transplant is considered successful if it lasts for 36 months without rejection. If you have a successful transplant, your Medicare coverage will end 36 months after you had the transplant.
• Your Medicare coverage will continue if you start getting dialysis or have a kidney transplant within 12 months of stopping dialysis. It will also continue if you start getting dialysis or have another kidney transplant within 36 months of having a transplant.

30-Month Coordination Period

When you get Medicare because of ESRD, there is a period of time when your employer group health plan will pay first and Medicare will pay second. This is called the 30-month coordination period, and it starts when you first qualify for Medicare coverage, even if you haven’t signed up for it yet.

At the end of the 30-month coordination period, Medicare will pay first for all Medicare-covered services and your employer group health plan will pay second. (Your employer group health plan may also pay for services not covered by Medicare. Call your benefits administrator to find out.)

Learn more about how your condition affects enrollment.

-Adapted from “A Plan to Cover More”, Medicare Watch, Medicare Rights Center, June 02, 2011 and “I am eligible for Medicare because I have ESRD. How do I enroll in Medicare?”, Medicare Interactive, Medicare Rights Center.

 

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