When does coverage for kidney disease take effect?
If you’re 65 or older, you can receive kidney-related benefits from Medicare anytime after you enroll.
For new enrollees younger than 65, Medicare coverage begins based on the dialysis or kidney transplant you need:
- If you’re using a dialysis center, Medicare coverage can start the first day of the fourth month of dialysis treatment and continues for up to 12 months after you stop dialysis.
- If you’re in a home dialysis program, your coverage can begin the first month of dialysis and continue for up to 12 months after you stop dialysis.
- If you’re getting a kidney transplant, you can generally receive Medicare benefits the month you’re admitted to the hospital. Coverage usually continues for 36 months after you’ve had the transplant and no longer need dialysis.
- If you need to resume dialysis or have another transplant, coverage will begin again without a waiting period. If you’re also eligible for Medicare because of another disability or because you’re 65 or older, your coverage won’t end.
- If you’re a transplant recipient and have met your 36-month coverage limit, starting in January 2023, Medicare Part B will continue to cover your transplant immunosuppressive drugs at 80 percent. This includes people who have no other insurance coverage that contains a benefit for anti-rejection drugs.
New rules for Medicare Advantage and kidney disease
People with end-stage renal disease now can receive coverage either through original Medicare or a private Medicare Advantage plan. Before the 21st Century Cures Act of 2016 opened the door to coverage beginning Jan. 1, 2021, people with kidney failure couldn’t enroll in Medicare Advantage.
At age 65, you can sign up for Medicare Advantage when you first enroll in Medicare parts A and B. You can also sign up or switch plans during open enrollment from Oct. 15 to Dec. 7, with new coverage starting Jan. 1.
If you’re younger than 65, you can enroll in Medicare Advantage when you first become eligible for Medicare under ESRD rules after signing up for parts A and B. You can also sign up for Medicare Advantage or switch plans during open enrollment each year.
Before choosing a Medicare Advantage plan, make sure your care team (including your primary care physicians, dialysis provider, nephrologist, transplant center and other specialists, such as cardiologists and endocrinologists) are part of the plan’s network. Review the coverage annually during open enrollment to verify that your providers are still in your network. If you’re pursuing a kidney transplant, find out how the plan will cover Part B medications, such as those to prevent rejection of the transplant.
Keep in mind
If you’re younger than 65 and qualify for Medicare because of ESRD, find out about your state’s rules on Medicare supplement policies, also called Medigap, before deciding between original Medicare and Medicare Advantage. These rules may be a deciding factor in your choice.
Even though you can buy a Medigap policy within six months of signing up for Medicare Part B at age 65, regardless of preexisting conditions, rules for younger people vary by state. These plans can help pay out-of-pocket costs for parts A and B of original Medicare.
Some states don’t have guaranteed issue rights for Medigap if a Medicare beneficiary is younger than 65, which makes it difficult to qualify for coverage with a preexisting condition such as ESRD. Contact the SHIP program in your area to learn more about your state’s rules.
Updated May 16, 2022
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