People with Disabilities

I have end-stage renal disease (ESRD). What are my coverage options under Medicare?

You are eligible for Medicare three months after beginning dialysis treatment or immediately after receiving a kidney transplant. You may want to find out if you qualify for Medicaid, if your income and assets are low enough. Medicaid helps many low-income people on Medicare with their Medicare premiums and cost-sharing requirements, and may also cover some benefits that are not covered by Medicare, such as dental services and long-term services and supports. To find out if you qualify, you can contact the State Medical Assistance Office or the State Health Insurance Assistance Program (SHIP) in your state. SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.

If you do not qualify for Medicaid, you may want to purchase a Medigap supplemental insurance policy to help cover the cost-sharing in traditional Medicare; however, while a few states require Medigap insurers to issue policies to people with ESRD, in most states, insurance companies are allowed to deny your application based on medical underwriting or can charge you higher premiums. Due to a change in law, people with ESRD will be allowed to enroll in a Medicare Advantage Plan for coverage in 2021 and future years. You can enroll during the open enrollment period (October 15 through December 7) for coverage that is effective beginning January 1, 2021. Note that you cannot use the Medicare Advantage open enrollment period (January 1-March 31) to newly sign up for a Medicare Advantage plan, because that enrollment period is only for people with current Medicare Advantage coverage to switch to another Medicare Advantage plan or to switch back to traditional Medicare.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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