Medicare and Renal Disease

End-Stage Renal Disease, or Kidney Disease, occurs when a person’s kidneys stop functioning for various reasons. There are over 660,000 Americans living with kidney disease.

Renal dialysis leading to a kidney transplant is one of the only ways to maintain life in a kidney disease patient. Today, more than 468,000 people with kidney disease need dialysis. There are more than 193,000 kidney disease patients who have had transplants.

Patients without proper health insurance coverage could find themselves facing high costs for dialysis, transplants and medications.

A surprise to some patients is that End-Stage Renal Disease might qualify them for Medicare.

How to Qualify for Medicare If You Have Kidney Disease

If you have kidney disease, you qualify for Medicare if you:

• Have paid into the Social Security or Railroad Retirement Board systems.
• Already receive Social Security benefits; or,
• Are a spouse or dependent child of someone who meets the above requirements.

How do I get Medicare?

Often, your doctor can direct you on the appropriate steps to register for Medicare. You can also visit your Social Security office to sign up and learn more about the requirements for getting coverage if you have kidney disease.

How much does Medicare pay?

Kidney disease patients qualify for both Medicare Part A and Part B during their time in the program. Medicare Part A covers hospital services like hospitalization, surgery and lab work. Medicare Part B covers supplies and services like doctor visits.

Medicare will act as a secondary insurance plan to your regular health insurance plan. The cost you will pay out of pocket will vary based on how Medicare payments combine with your regular plan’s payments. The cost with Medicare is usually less than if you do not have Medicare.

How long does coverage last?

If you are only receiving Medicare because you have kidney disease, then your coverage is not permanent. It will end based on when you stop dialysis treatments or have a kidney transplant.

Coverage usually ends:

• 12 months after the final month of your dialysis treatments.
• 36 months after your kidney transplant.

If you have to go back on dialysis or have another transplant, you can often qualify for Medicare again.