Your Guide to ESRD Medicare Benefits

End-Stage Renal Disease ESRD Medicare benefits are available in specific situations. Generally, Medicare support is offered to applicants who are at least 65 years of age and worked enough to collect benefits. However, these same requirements do not necessarily apply to ESRD applicants who want to enroll in Medicare. The relationship between petitioners with ESRD and Medicare varies slightly.

Whether you are interested in enrolling in the ESRD Medicare Advantage program or another part of this initiative, it is important that you understand how to apply for benefits. Likewise, you need to be sure that you qualify to enroll. However, once you understand the Medicare ESRD rules, you could be able to enroll and receive valuable support.

ESRD Medicare Eligibility

Before you submit your ESRD Medicare application form, make sure you qualify to enroll. Regardless of how old you are, you could qualify for Medicare if you have kidney failure, need consistent dialysis or received a kidney transplant. However, Medicare guidelines for ESRD applicants also state that you must meet one of the following requirements to enroll:

  • Applicants must have worked enough to collect benefits through Social Security, as a government worker or from the Railroad Retirement Board (RRB).
  • Petitioners must already be receiving or be eligible to receive RRB or Social Security benefits.

If applicants do not meet either of the aforementioned requirements, they can still qualify for Medicare for kidney failure. This is possible if they have a spouse or are the dependent of someone who met those requirements.

Can you enroll in Medicare Advantage with ESRD?

Generally, ESRD Medicare Advantage eligibility is limited. This means that not every applicant with ESRD qualifies to enroll in Medicare Advantage, which is also called Medicare Part C. However, there are some instances when individuals can enroll in this program part. These Medicare Advantage ESRD exceptions for enrollment include:

  • Candidates who developed ESRD after they enrolled in a Medicare Advantage Plan.
  • Applicants whose current health insurance providers also offer a Medicare Advantage Plan.
  • Petitioners who received successful kidney transplants after being diagnosed with ESRD, and who also qualify for Medicare based on their disability or age.
  • Candidates were able to enroll in a location-specific Medicare Special Needs Plan (SNP), which serves as a type of Medicare Part C.

How to Apply for ESRD Medicare Benefits

Generally, you can submit your ESRD Medicare application for benefits the same way you would apply for regular enrollment. This means you can apply by contacting the Social Security Administration (SSA). You can also apply by submitting your application in person at a Social Security office near you.

When does Medicare become primary coverage for ESRD enrollees?

Medicare ESRD enrollment is important to understand. Furthermore, you also need to make sure you are aware of when this health insurance can become your primary provider. If the following criteria apply to you, you could have ESRD Medicare primary coverage:

  • You are not enrolled in Medicare solely because you have ESRD.
  • You are not within a 30-month coordination period.
  • You are not insured by a Group Health Plan.

The Medicare ESRD Coordination Period

Your ESRD Medicare coverage begins after you are past your initial 30-month coordination period. Usually, your coordination period begins during the fourth month you are receiving dialysis. This is also considered the time when you are diagnosed with permanent kidney failure.

During this Medicare coordination of benefits period, your current employer group health plan will keep paying your medical bills relating to ESRD. Keep in mind that this time period begins even if you do not sign up for benefits during your fourth month of dialysis.

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