Medicare & End-Stage Renal Disease (ESRD): What’s Covered?

If you or a loved one has been diagnosed with End-Stage Renal Disease (ESRD) — also known as kidney failure — you may be wondering: Does Medicare help? The answer is:  Yes. Medicare covers dialysis, kidney transplant, and much more — even if you’re under age 65. Here’s what you need to know about ESRD and Medicare, what’s covered, and how to get started.

 What Is ESRD?

End-Stage Renal Disease (ESRD) is when your kidneys stop working and you need:

• Regular dialysis (hemodialysis or peritoneal dialysis), or
• A kidney transplant

It’s a serious condition — but Medicare offers strong support, even if you’re younger than 65.

 Who Qualifies for Medicare Due to ESRD?

You may qualify for Medicare at any age if:

• You’ve been diagnosed with ESRD by a doctor
• You’ve worked long enough (or are the spouse/child of someone who has)
• You start a course of regular dialysis or have a kidney transplant

 Medicare coverage begins:

• 4th month of dialysis (can start earlier if you're in training for home dialysis)
• Month of transplant, or two months before if you’re admitted early for pre-transplant services

 What Medicare Covers for ESRD

Covered by MedicareExamples

Dialysis Services	In-center or at-home dialysis, training, supplies, medications
Kidney Transplants	Surgery, hospital stay, labs, and doctor visits
Immunosuppressive Drugs	Covered under Part B if you had Medicare at the time of the transplant
Doctor Visits	Nephrologist and related specialists
Hospital Care	If you're admitted for ESRD-related treatment
Home Health Care	If ordered by your doctor

 Part D plans may cover additional medications not related to the transplant or dialysis.

 Medicare Part A, B, and D: How They Help with ESRD

Part A (Hospital Insurance)

• Covers transplant surgery, inpatient dialysis, and hospital stays

Part B (Medical Insurance)

• Covers dialysis treatments, lab work, doctor visits, and immunosuppressive drugs
• You’ll pay the standard monthly premium

Part D (Prescription Drug Plan)

• Covers drugs not included under Part B — such as phosphate binders or nausea meds

 Some ESRD medications are split between Part B and D depending on how and where they're administered.

 Medicare Advantage and ESRD — What Changed?

Until 2021, people with ESRD generally couldn’t enroll in Medicare Advantage (MAPD) plans.  But now, you CAN enroll in an MAPD plan during the Annual Enrollment Period (Oct 15–Dec 7) or during your Initial Enrollment Period. Many MAPD plans now offer:

• Coordinated kidney care
• Transportation
• Dental, vision, OTC cards
• $0 drug copays for ESRD-related meds

 Check for specialized ESRD or C-SNP plans in your ZIP code — we can help!

 FAQs: ESRD and Medicare

1. Can I get Medicare before age 65 if I have ESRD?

 Yes — Medicare for ESRD is not age-based.

2. Will Medicare cover a kidney transplant?

 Yes — including surgery, pre- and post-op care, and immunosuppressive medications.

3. How long will Medicare cover me after a transplant?

• If you're under 65, Medicare ends 36 months after your last transplant
• Exception: If you’re receiving immunosuppressive drugs, you may continue getting Part B only just for those meds

4. Can I delay Part B if I have employer coverage?

In most ESRD cases — no. You usually need to take Part B immediately to ensure full coverage for dialysis and transplant services.

 Need Help Enrolling in Medicare for ESRD?

At Peace & Grace Insurance Services, we help people:

• Enroll in Medicare due to kidney failure
• Choose between Original Medicare and MAPD ESRD plans
• Check drug coverage and doctor networks
• Apply for Extra Help or Medi-Cal to reduce costs

 Call/Text: 209-812-4026  Email: CSinsurepng@icloud.com  Proudly serving all counties in California