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Medicare coverage may be available to people with end-stage renal disease even before they reach their 65th birthday. But what happens if you recover? Do you lose your Medicare coverage?
According to the Centers for Medicare and Medicaid Services (CMS), end-stage renal disease (ESRD) is defined as a permanent condition in which a person’s kidneys no longer function adequately, requiring ongoing dialysis or a kidney transplant.
Do you have ESRD? Here are the specifics you should know about your Medicare coverage for end-stage renal disease.
Can I lose Medicare coverage for end-stage renal disease?
If you have Medicare only because you have end-stage renal disease – and you’re under age 65 – it is possible to lose your Medicare coverage if you’re successfully treated for it. Here are two ways you might lose your Medicare coverage for end-stage renal disease:
- If you stop getting dialysis treatments, your coverage may stop the 12th month after your last dialysis treatment.
- If you get a kidney transplant, your Medicare generally ends 36 months after the transplant surgery takes place.
You can usually extend your Medicare coverage for end-stage renal disease if you go back on dialysis again or if you get a kidney transplant within a year from stopping your dialysis treatments.
If you get another kidney transplant within three years from the date of your first kidney transplant, you can also extend your Medicare benefits for another 36 months from the date of the second transplant.
If you have Medicare because you are 65 or older, you cannot lose your Medicare coverage even if you’ve had successful treatment for your end-stage renal disease.
How do I get Medicare coverage for end-stage renal disease in the first place?
You can usually get Medicare at any age if you have been diagnosed with end-stage renal disease (ESRD) and any of the following applies to you:
- You have qualifying work history under Social Security, the Railroad Retirement Board (RRB), or as a government employee.
- You are already getting Social Security or RRB benefits.
- You’re the child or spouse of someone who qualifies under one of the two situations above.
What does Medicare cover with end-stage renal disease?
Your Original Medicare coverage under Part A and Part B covers most services and supplies associated with hemodialysis to treat your end-stage renal disease. Even if you don’t have Medicare Part D coverage for prescription drugs, Part B will cover most drugs you need for dialysis, either in home or at a facility. If you get your dialysis in a hospital setting, Part A covers all allowable charges associated with your treatment. Deductibles, copayments, and coinsurance amounts may apply.
If you get a kidney transplant to treat ESRD, Part A and Part B may provide comprehensive coverage for allowable charges, provided you have your surgery at a Medicare-certified hospital for kidney transplants. Part B also covers your immunosuppressive drugs following transplant for a specific period of time, usually 36 months.
Keep in mind that Part B only covers certain prescription medications specifically associated with your end-stage renal disease. Even if you have other conditions such as high blood pressure that may be related to ESRD, Part B does not cover prescription drugs used to treat those conditions. You will need Medicare Part D prescription drug coverage if you want coverage for those medications.
Need more information on Medicare coverage options when you have end-stage renal disease?
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