En español | Permanent kidney failure is a condition known as “end-stage renal disease” (ESRD) in Medicare. It means that your kidneys have stopped working properly and you need either regular dialysis to keep them functioning or a kidney transplant. In this situation, the usual two-year waiting period for Medicare (required of most people who qualify on the basis of disability) is waived. But you still have to meet conditions for eligibility:
The rules for when Medicare coverage starts depend on what kind of care you need (dialysis or kidney transplant) and whether you also have coverage under an employer plan. If you receive Medicare on the basis of having ESRD only, the coverage continues 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 coverage begins again without a waiting period.
Because these rules are quite complicated and depend on your circumstances, call Social Security at 800-772-1213 to find out how they apply to you. You can also check out the official publication “Medicare Coverage of Kidney Dialysis & Kidney Transplant Services” at https://www.medicare.gov/Pubs/pdf/10128-Medicare-Coverage-ESRD.pdf.
When you qualify for Medicare because of ESRD you will automatically receive your care under the original Medicare program. You cannot enroll in a private Medicare Advantage health plan (such as an HMO or PPO) if you already have ESRD. However, if you have Medicare on the basis of age or another disability, and you’re already enrolled in a Medicare Advantage plan when you develop ESRD, you can stay in your plan.