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
