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End Stage Renal Disease (ESRD) and Medicare

April 14, 2020

If you have End Stage Renal Disease (ESRD), that is your kidneys are no longer working and you need regular dialysis treatments or a transplant, then you may be eligible for Medicare no matter what age you are.

Other factors which affect your eligibility include whether you have met the required work time for Social Security, already receiving or eligible for Social Security or Railroad Retirement Benefits, or if you are a dependent or spouse of an eligible claimant.

If you are still trying to work with ESRD and your Substantial Gainful Activity (SGA) for 2020, is under $1260 per month or $2110 per month if you are blind, you may be eligible for cash benefits due to your disability.

Once you've been diagnosed with ESRD and you're receiving dialysis treatment, your Medicare coverage will likely begin on the first day of the 4th month of your dialysis treatment, even if you haven't filled out an application for Medicare. Though, Medicare also comments that if you don't enroll in Medicare until after you've met all the requirements, your coverage period could start up to 12 months prior to the month you apply. There are some things Medicare does not cover and they should be contacted for further information.

For Medicare coverage you will need Part A and Part B in order to cover certain dialysis and medical services for a future kidney transplant. If you have a pre-existing health insurance policy that insurance will be your primary and charged first. Then Medicare acts as your secondary insurance. If you have pre-existing health insurance coverage it acts as a 30-month coordination period. Then, at the end of the 30 months, Medicare starts paying for Medicare covered services.

If you are filing for Medicare based on ongoing dialysis treatments or for a kidney transplant, you have to visit the local Social Security Office.

Finally, there are expedited payments for ESRD available for those who are making an initial application or receive benefits already, are due SSI benefits and these are delayed, and who are in a “financial emergency” involving money for food, housing, medical care or clothing.

This blog is intended for information purposes only and does not establish legal representation or financial guidance.