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Medicare Benefits for People with ESRD

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Medicare benefits aren’t just for people aged 65 and over. If you have kidney failure, you might qualify for Medicare benefits.

Permanent kidney failure is a condition known as “end-stage renal disease” (ESRD). It means that your kidneys have stopped functioning properly and you need either regular dialysis or a kidney transplant. You may be able to get Medicare benefits if you have been diagnosed with ESRD, even if you are younger than age 65.

Am I eligible for Medicare benefits if I have ESRD?

You have to meet conditions for eligibility for Medicare benefits if you’re under 65:

  • You must be diagnosed with ESRD by a doctor.
  • One of the following situations must apply to you.
  • You have enough work history to qualify for Social Security Disability Insurance (SSDI), or enough railroad work history to qualify for Railroad Retirement disability annuity benefits.
  • You are the spouse or the dependent child of a person who has enough work history to qualify for SSDI or Railroad Retirement benefits.

In most cases you cannot enroll in a Medicare Advantage plan (unless it is a Special Needs Plan) after you have been diagnosed with ESRD.

How do I sign up for Medicare benefits if I have ESRD?

With some types of disability, you’ll be automatically enrolled in Medicare. But with ESRD, if you’re not yet 65, you typically have to enroll in Medicare yourself.

You can contact the Social Security Administration (SSA) at 800-772-1213 to learn if you have enough work history to qualify for Medicare benefits, and to enroll. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM in all U.S. time zones.

If you worked for a railroad, call the RRB at 1-877-772-5772 (TTY users call 1-312-751-4701), Monday through Friday, 9AM to 3:30PM in all U.S. time zones, to speak to an RRB representative.

Your provider and/or dialysis center may have to provide documentation verifying that you have ESRD and stating your treatment needs.

When do my Medicare benefits start if I have ESRD?

When your Medicare benefits start depends on what kind of care you need (dialysis or kidney transplant). Social Security (or the RRB) can tell you when your Medicare benefits will start. Usually your Medicare benefits continue until 12 months after you stop dialysis treatments, or 36 months after you’ve had a kidney transplant and no longer need dialysis. But if you need to resume dialysis or have another transplant, Medicare benefits may resume without a waiting period.

What are my Medicare benefits if I have ESRD?

When you qualify for Medicare benefits due to ESRD, you’ll typically enroll in Original Medicare, Part A (hospital insurance) and Part B (medical/outpatient insurance). You need to use Medicare-approved facilities and be treated by providers who accept Medicare assignment.  Your Medicare Part A and Part B benefits may help pay for care related specifically to ESRD, which may include:

  • Hospital stay and treatment-associated services
  • Kidney transplants and hospital inpatient stays (including your donor’s inpatient stay)
  • Hospital inpatient dialysis
  • Outpatient dialysis from a Medicare-certified hospital or free-standing dialysis facility
  • Home dialysis training, sometimes called self-dialysis, from a dialysis facility
  • Training for you and caregivers who will provide home dialysis
  • Home dialysis equipment and supplies
  • Certain medications related to treatment
  • Immunosuppressant drugs after a kidney transplant, as long as you had Medicare Part A at the time of the transplant and have Medicare Part B.

Augment your Medicare benefits with a Medicare Supplement plan

If you have a lot of doctor visits, you might want to think about buying a Medicare Supplement plan. This kind of plan is designed to help pay your out-of-pocket Medicare Part A and Part B costs. There are several standardized plans in most states. Learn about Medicare Supplement insurance plans.

It’s easy to compare Medicare Supplement plans – just enter your ZIP  code on this page to begin. Would you like to learn more about Medicare benefits? If so, feel free to contact eHealth to speak with a licensed insurance.

The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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