Medicare Coverage for ESRD (End Stage Renal Disease)
People with End Stage Renal Disease (ESRD) can receive dialysis and other health care services at Medicare-approved facilities.
Depending on where you live, you may be able to apply for a Medicare Supplement Insurance (Medigap) plan that helps pay some of your Medicare costs for ESRD treatment.
When Does Medicare Cover ESRD?
Medicare coverage for ESRD has been in place since Congress passed the Social Security Amendment in 1972.
To get Medicare coverage for dialysis treatment or a kidney transplant, you must be enrolled in Original Medicare (Part A and Part B).
Typically, Medicare coverage begins on the first day of the fourth month of dialysis treatments. This is the waiting period for patients who receive Medicare specifically for their ESRD.
If you are equipped and trained for home dialysis, you can reduce or eliminate the waiting period:
Complete Medicare approved training for home dialysis.
Be confident that you are capable of managing your own dialysis in the home.
Continue to receive dialysis treatments as if the waiting period was in effect.
Medicare beneficiaries should remember that benefits under Part B are subject to a deductible and 20% coinsurance.
What Is the Primary Cause of ESRD?
Diabetes and high blood pressure are both linked to kidney failure.
Other risk factors include:
Family history of chronic kidney disease (CKD)
Past damage to the kidneys
The kidneys remove water and waste from blood, and dialysis is a medical process to fulfill that function when the kidneys fail.
Medicare Supplement Plans In Some States Can Help Cover ESRD
Depending on where you live, ESRD patients may be able to purchase Medicare Supplement Insurance plans, also called Medigap. There are 10 standardized Medigap plans available for purchase from private insurance companies in most states.
At least 27 states require Medigap plans to be available to patients under 65 with ESRD. This helps make treatment for kidney failure much more affordable for many Medicare beneficiaries.
Learn more about Medicare coverage of common procedures
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
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Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.