End-Stage Renal Disease Medicare Coverage

The diagnosis of kidney failure is something that's very hard for anybody to deal with. However, by understanding how Medicare coverage for end-stage renal disease actually works, you can better understand the options that you have available for managing such a diagnosis. In addition to this unofficial article, it's important to also read official government informational packets which you can acquire through your hospital, or through visiting www.medicare.gov, or by calling 1-800-MEDICARE (1-800-633-4227).

Typically, Medicare helps pay for the kidney dialysis machine and further surgeries, however you cannot join a Medicare Advantage Plan (such as an HMO or PPO). Medicare typically covers only patients age 65 or older, or under 65 with certain disabilities. Fortunately, Medicare coverage for end-stage renal disease extends to cover patients of any age (not just the elderly or people with pre-existing disabilities). Medicare Part A primarily relates to inpatient hospital care and care by medical workers. Part B also contains important services for this condition, including outpatient care and home health care. While Medicare Part A typically involves no premiums (as the beneficiary paid taxes while they worked), Medicare Part B premiums usually average at about $115.00 per month. The premium charge for Part B is usually taken out of your monthly Social Security or Railroad Retirement payment.

Medicare coverage for end-stage renal disease applies to any age. However, to be applicable for Medicare coverage you must still meet government policies that regulate those eligible for the service. You must have worked the required amount of time while paying into Social Security, or have worked the proper amount of time as a government employee, and you must already be receiving the benefits of Social Security (or Railroad Retirement benefits). In addition, you may also apply if you are the dependent or the spouse of somebody who is already eligible for Medicare through the above requirements. If you do not qualify for Medicare, you should consider contacting your state government for information about other programs to help pay for your dialysis, especially if you are low-income.

Medicare coverage for end-stage renal disease requires both Medicare Part A and Part B coverage in order to receive the full benefits, which includes dialysis and kidney transplant operations. Fortunately, qualifying for Part A also entails immediate qualification for Part B as well. After you acquire coverage for Part A and B, you may also add coverage to assist with prescription drug coverage through applying for the Medicare Prescription Drug Plan (Part D), which is sponsored by private firms. This will assist with the cost of necessary drugs required after a kidney operation or during the process of dialysis.

Your Medicare coverage for end-stage renal disease typically begins on the fourth month of your dialysis treatment. As an example, if you began your dialysis on January 1st, by April 1st your Medicare coverage will begin. However, Medicare coverage for dialysis may begin on the first month if you meet certain conditions. These include a Medicare home dialysis training program, which is taught through Medicare-approved training centers which teach self-administered dialysis treatments. Afterwards, your doctor must confirm that you've finished your training, and that you can handle your own treatments effectively.

On the other hand, Medicare coverage for end-stage renal disease begins the very month you get a kidney transplant, but only if you're admitted to a Medicare-approved hospital and your transplant occurs within 2 months of admittance. This means that even if your transplant is delayed, as long as you are properly admitted on-time, you will still be covered by the benefits of Medicare. However, it's important to note that Medicare will not cover the costs incurred by surgery and other operations that are pre-requisites to begin dialysis treatment before Medicare coverage begins. There may be options around this, including the completion of the home-dialysis training. Speak to your health provider to help ensure a clearer understanding of what options are available.

Medicare coverage for end-stage renal disease will traditionally end 12 months after the month you stop dialysis treatments, or 36 months after the month of your kidney transplant operation. Coverage, however, may continue based on certain conditions, such as if dialysis must begin again. Medicare coverage will, of course, continue to cover you based on pre-existing eligibility for Medicare to treat separate conditions.

While this is the basic information to understand Medicare coverage for end-stage renal disease, it's important to note there are many other areas of information to become aware of. By visiting www.medicare.gov and speaking to your doctor, you can learn many more details, including what specific areas are covered by Medicare (and what isn't), and important facts to better understand the kidney dialysis process. Although a diagnosis of ESRD can be a very difficult emotional time, understand that many other Americans are sharing similar circumstances with you, and must also undertake the same preparations and strategies in learning how to effectively recover from this diagnosis and return to a normal way of life.