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(Part of the Anthem Blue Cross Family) in Los Angeles, Orange, San Bernardino  and other areas.

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I have ESRD. Am I eligible for Medicare?

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 (RRB), 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.

Contact Social Security for more information about the amount of time required to be eligible for Medicare. (CMS)

***Two years?  Must get disability first?

If you get benefits from the Railroad Retirement Board (RRB), contact the Railroad Retirement Board.

 

Can one buy a Medi-Gap policy if they have Medicare A & B and have ESRD?

If you have a Medi Gap plan before you are diagnosed with ESRD, you can keep it.  There is also a guaranteed issue opportunity when you turn 65,   Medicare Publication Kidney Dialysis & Transplant Services # 10128.  page 42.   If you are not in a guaranteed issue period, here’s the underwriting questions, so forget it.

 

Check out Medicare Advantage Special Needs Plans
like Caremore/Blue Cross

 

Resources & Links

ESRD Info on Medicare Website

Medicare Publication #10128 End Stage Renal – 60 Pages – More than you ever wanted to know 

Medicare Info for Children with End Stage Renal Disease (ESRD) From CMS.Gov

From KidneyFund.org 

davita.com  Kidney Care Resource Web MD on Chronic Kidney Disease

42 U.S. Code § 1395rr – End stage renal disease program

 

More Links

Medicare Advantage 

Medi-Gap (Supplements)  ♦

Cost of dialysis   ♦

CMS Publication 11037 Out of Country  ♦

Kidney.org – Travel

Pre-X for International Travel Plans  ♦

Medicare Outside of USA Insbuy

 

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions

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Medicare covers the substantial costs associated with End Stage Renal Disease (ESRD) for the vast majority of kidney patients. How will this coverage change under the newly implemented Affordable Care Act, also known as Obamacare?

6 comments on “End Stage Renal – Kidney Failure

    • End-Stage Renal Disease (ESRD)—Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.

      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,
      https://www.medicare.gov/Pubs/pdf/10128-Medicare-Coverage-ESRD.pdf?

      Having kidney failure means that:

      85-90% of your kidney function is gone
      your kidneys don’t work well enough to keep you alive
      https://www.kidney.org/atoz/content/KidneyFailure

      When the beneficiary first enrolls in Medicare based on ESRD, Medicare coverage usually starts:

      1. On the fourth month of dialysis when the beneficiary participates in dialysis treatment in a dialysis facility.

      2. Medicare coverage can start as early as the first month of dialysis if:

      The beneficiary takes part in a home dialysis training program in a Medicare-approved training facility to learn how to do self-dialysis treatment at home;
      The beneficiary begins home dialysis training before the third month of dialysis; and
      The beneficiary expects to finish home dialysis training and give self-dialysis treatments.
      Example: If the beneficiary starts home dialysis training in a Medicare approved facility, or if a course of home self-dialysis training is begun before the third month of dialysis, or if the beneficiary is expected to finish home dialysis training and perform self-dialysis on July 17th, the Medicare entitlement date would be July 1st.

      3. Medicare coverage can start the month the beneficiary is admitted to a Medicare-approved hospital for kidney transplant or for health care services that are needed before the transplant if the transplant takes place in the same month or within the two following months.

      Example: If the beneficiary has a kidney transplant on July 17th, the Medicare entitlement date would be July 1st.

      4. Medicare coverage can start two months before the month of the transplant if the transplant is delayed more than two months after the beneficiary is admitted to the hospital for that transplant or for health care services that are needed before the transplant.

      Example: If on July 17th the beneficiary starts pre-surgical health care services that are needed prior to a kidney transplant and the transplant is performed on September 4th, the Medicare eligibility date would be July 1st, since the transplant was performed within two months of the pre-surgical services.

      5. Medicare coverage can start two months before the month of the transplant if the transplant is delayed more than two months after the beneficiary is admitted to the hospital for that transplant or for health care services that are needed before the transplant.

      Example: The beneficiary was admitted to the hospital on May 25th for some tests that are needed before a kidney transplant. The transplant was to be on June 15th; however, the transplant was delayed until September 15th. Therefore, the beneficiary’s Medicare coverage will start on July 1st, two months before the month of transplant.https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/End-Stage-Renal-Disease-ESRD/ESRD.html

      https://www.kidney.org/sites/default/files/docs/esrd_medicare_guidelines.pdf

      Kidney failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. End-stage renal disease (ESRD) is when the kidneys permanently fail to work. https://stanfordhealthcare.org/medical-conditions/liver-kidneys-and-urinary-system/kidney-failure.html

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