Medicare for those with End-Stage Renal Disease (ESRD Medicare) provides you with health coverage if you have permanent kidney failure that requires dialysis or a kidney transplant. ESRD Medicare covers a range of services to treat kidney failure. In addition, you will also have coverage for all the usual services and items covered by Medicare.
ESRD Medicare eligibility
To be eligible for ESRD Medicare, you must be under 65 and diagnosed with ESRD by a doctor. Additionally, you must have enough work history to qualify for Social Security Disability Insurance (SSDI) or Social Security retirement benefits, or enough railroad work history to qualify for Railroad Retirement benefits or railroad disability annuity. You can also qualify through the work history of your spouse or parent.
Contact the Social Security Administration (SSA) at 800-772-1213 to learn if you have enough work history to qualify for ESRD Medicare.
ESRD Medicare enrollment
To enroll in ESRD Medicare, visit your local Social Security office. (Even if you qualify based on prior railroad work, Social Security is responsible for handling your ESRD Medicare enrollment.) Your provider and/or dialysis center should send documentation to Social Security verifying that you have ESRD and stating your treatment needs. If you are unable to enroll yourself due to illness, a family member or other designated party can enroll for you.
When ESRD Medicare coverage begins
When your ESRD Medicare begins depends on your treatment plan:
- If you start a home dialysis training program, sometimes called self-dialysis, you are eligible for Medicare starting the first day of the first month of the home dialysis program. You must start the program before your third month of dialysis. Additionally, your doctor must state that they expect you can complete the program and will continue home dialysis after the program ends.
- If you receive dialysis at an inpatient or outpatient dialysis facility, you are eligible for Medicare starting the first day of the fourth month you receive dialysis. For example, if you begin receiving dialysis on May 10, your ESRD Medicare can start on August 1.
- If you are going to receive a kidney transplant, you are eligible for Medicare starting the month you are admitted to a Medicare-approved hospital for the transplant, or for health services you need before getting the transplant.
- 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.
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