ESRD: Medicare
& End-Stage Renal Disease

Home » Medicare Covered Conditions » ESRD Medicare Coverage (End-Stage Renal Disease)

If you have End-Stage Renal Disease (ESRD), you may wonder what your healthcare options are, especially when it comes to Medicare. It’s our job to make Medicare easy. Here’s what you need to know.

Female doctor in white coat sitting with senior patient and reviewing information on a tablet

Automatic Medicare Enrollment with ESRD

Generally, Medicare enrollment eligibility begins three months before the month you turn 65. Individuals receiving disability insurance may enroll early, although Medicare requires a 24-month delay after recipients begin receiving disability benefits. That’s not the case if you have ESRD, as eligibility as a result of disability can happen at any age. Unlike other disabilities, if you have ESRD, Original Medicare (Parts A and B) coverage begins after your fourth month of dialysis treatment. Coverage may begin after your first month of treatment if you meet these eligibility requirements:

  • You participate in a Medicare-approved program that teaches you how to perform self-dialysis at home during the first three months of treatment
  • Your doctor expects you to be able to do your own dialysis treatments

If you have ESRD, you should receive a Medicare card in the mail when your coverage starts. This card is red, white and blue and states your Medicare Number. You will need this number if you choose to enroll in a Medicare Advantage, Medicare Supplement Insurance (Medigap), or Prescription Drug plan.

Could You Get a Medicare Advantage Plan with Extra Benefits?
Get a Free Consultation with a Licensed Agent.

Original Medicare ESRD Coverage

Medicare Parts A and B, also known as Original Medicare, can offer coverage for select services and equipment. You are responsible for the 20 percent Medicare coinsurance for all Medicare-covered services.

  • Medicare Part A (hospital care) will cover necessary treatment that occurs at an inpatient facility, like a hospital. For example, Part A will cover kidney transplant surgery or dialysis treatment in the hospital.
  • Medicare Part B (medical care) will cover specific prescription drugs related to a kidney transplant or dialysis. Part B will also cover dialysis in an outpatient facility or at home.

If you are under 65 and you have stopped dialysis treatments for 12 months or are 36 months post-op from a kidney transplant, your Original Medicare coverage will end. It will start again if you resume dialysis or have another kidney transplant.

Original Medicare doesn’t include coverage for prescription drugs outside of those related to ESRD transplants or dialysis. If you need or want coverage for other medications, you will need to enroll in a Medicare Part D prescription drug plan. You can enroll in a standalone Part D plan, or choose a bundled plan that includes Part A, Part B, and Part D. These plans are known as Medicare Advantage Prescription Drug plans (Part C).

Are Your Medication Costs Adding Up?
Ask About Medicare Plans That Include Prescription Drug Coverage.

Additional benefits through Medicare Advantage

If you have ESRD, you may find that you are looking for more coverage or benefits than Original Medicare can provide. Medicare Advantage plans are offered by private insurance companies and include all of the same coverage as Original Medicare as well as additional benefits in a single plan. Often, Medicare Advantage plans offer low-to-no cost premiums, deductibles and copay/coinsurance. You are still responsible for your Part B premium.  Examples of additional coverage include:

  • Vision
  • Dental
  • Hearing
  • Prescription Drugs
  • Fitness
Image

ESRD Special Needs Plan

Medicare Chronic Special Needs Plans (C-SNP) are a type of Medicare Advantage plan that offer coverage and benefits specific to certain conditions, such as End-Stage Renal Disease. This means that these plans may offer access to specialists and cover common prescriptions used by individuals with ESRD.

Get Medicare Coverage that Fits Your Needs
Explore Medicare Advantage Plans In Your Area

Frequently Asked Questions

What is ESRD (End-Stage Renal Disease)?

Also known as end-stage kidney disease or kidney failure, ESRD is when your kidneys are in permanent failure, to the point where you need regular dialysis or a transplant.

Does Medicare cover dialysis?

Yes. Medicare Part B covers dialysis for individuals with ESRD. As with all Medicare-covered services, you are responsible for the 20 percent Medicare coinsurance. 

Does Medicare cover a kidney transplant?

Yes. Medicare Part A will cover a kidney transplant if it’s performed in a Medicare-approved hospital. However, as with all Medicare-covered services, you are responsible for the 20 percent Medicare coinsurance.

Does Medicare cover a pancreas transplant?

Yes. Medicare Part A will cover a pancreas transplant if it’s performed in a Medicare-approved hospital. However, as with all Medicare-covered services, you are responsible for the 20 percent Medicare coinsurance.

Speak to a Licensed Agent Today

1-800-991-4407 / TTY 711

Mon-Thu 8am-11pm, Fri 8am-9pm, Sat 10am-6pm EST


Privacy Policy | Terms of Use | Contact Us | Content Review Process

e-TeleQuote Insurance Inc. (“e-TeleQuote”), an affiliate of Primerica, Inc., does business as easyMedicare® in all states other than California, Florida and New Mexico. e-TeleQuote is a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. By using e-TeleQuote’s easyMedicare website, you understand and agree that in California, Florida and New Mexico, we operate as e-TeleQuote Insurance, Inc. (Your IP address and/or location coordinates may be gathered to verify your location.) Sales agents/producers may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. easyMedicare.com is a non-government site, powered by e-TeleQuote Insurance, Inc. e-TeleQuote provides a secure way to purchase Medicare insurance from the comfort of your home or workplace. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M