2015 Medicare for people with End-Stage Renal Disease Training Presentation
The lessons in this module, “Medicare for People With End-Stage Renal Disease,” explain the Medicare program for people with End-Stage Renal Disease (ESRD). It includes information on eligibility and enrollment, coverage, health plan options, and provides additional sources of information. Medicare ESRD training presentation at end of post.
ESRD is defined as permanent kidney failure that requires a regular course of dialysis or a kidney transplant. In 1972, Medicare was expanded to include 2 new groups of people: certain people with a disability and those with ESRD. The expanded coverage began in 1973.
You can get Medicare no matter how old you are if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of these applies to you:
You’ve worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee
You’re already getting or are eligible for Social Security or Railroad Retirement benefits
You’re the spouse or dependent child of a person who meets either of the requirements listed above
- You may be eligible based on the earning records of a current or prior same-sex spouse if you
- Were married in a state that permits same-sex marriage
- Were living together at the time of the application, or while the claim was pending final determination in a state that recognizes same-sex marriage, and
- Were married for at least 10 years (if divorced)
You must also file an application, and meet any deadlines or waiting periods that apply.
NOTE: See CMS Product No. 11392 “Medicare for Children With End-Stage Renal Disease,” at Medicare.gov/Pubs/pdf/11392.pdf for more information regarding children with ESRD.
If you qualify for Medicare Part A, you can also get Medicare Part B (Medical Insurance). Enrolling in Part B is your choice and isn’t automatic. If you don’t enroll in Part B when you get Part A, you must wait until a General Enrollment Period (January 1–March 31 each year) to apply, and you may have to pay a late enrollment penalty. You’ll need both Part A and Part B to get the full benefits available from Medicare to cover certain dialysis and kidney transplant services.
Call your local Social Security office to make an appointment to enroll in Medicare based on End-Stage Renal Disease (ESRD), and for more information about the amount of work needed under Social Security or as a federal employee to be eligible for Medicare. You can contact Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you work or worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. TTY users should call 1-312-751-4701.
NOTE: If you don’t qualify for Medicare, you may be able to get help from your state Medicaid agency to pay for your dialysis treatments. Your income must be below a certain level to receive Medicaid. In some states, if you have Medicare, Medicaid may pay some of the costs that Medicare doesn’t cover. To apply for Medicaid, talk with the social worker at your hospital or dialysis facility or contact your local Department of Human Services or Social Services.
You can enroll in Medicare Part A and Part B based on ESRD at your local Social Security office. Social Security will need your doctor or the dialysis facility to complete Form CMS-2728 to document that you have ESRD and can get Medicare. If Form CMS-2728 is sent to Social Security before you apply, the office may contact you to ask if you want to complete an application.
In general, Medicare is the secondary payer of benefits for the first 30 months of Medicare eligibility (known as the 30-month coordination period) for people with ESRD who have an employer group health plan or union group health plan (GHP) coverage. If your GHP coverage will pay for most or all of your health care costs (for example, if it doesn’t have a yearly deductible), you may want to delay enrolling in Part A and Part B until you’re getting near to the end of the 30-month coordination period. If you delay enrollment, you won’t have to pay the Part B premium for coverage you don’t need yet. After the 30-month coordination period, you should enroll in Part A and Part B.
If you’ll soon receive a kidney transplant, get the facts about eligibility and enrollment before deciding to delay because there are shorter time periods for eligibility and enrollment deadlines for transplant recipients (see slides 14–16).
Call Social Security at 1-800-772-1213 to make an appointment to enroll in Medicare based on ESRD. TTY users should call 1-800-325-0778.
View the full ESRD training presentation below
2015-Medicare-for-People-with-End-Stage-Renal-Disease-Workbook.pdf
