What to Know About Automatic Medicare Approval for Kidney Failure


End Stage Renal Disease (ESRD) is a disease with no cure. And the only way to survive this devastating illness is to receive a kidney transplant. But until that happens, patients must rely on a dialysis machine that does what healthy kidneys normally do. According to the National Kidney Foundation, almost 500,000 Americans currently require dialysis. This painful and debilitating treatment makes working nearly impossible – which affects patients and their families. Fortunately, the Social Security Administration (SSA) offers two programs that can help dialysis patients: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). In addition, federal law requires that Medicare covers all patients with ESRD – including adults and children.

Automatic Medicare Approval for ESRD Patients After You Apply

Medicare eligibility based on ESRD works differently than other types of Medicare coverage. If you have ESRD and don’t enroll right away, you may be eligible for 12 months of retroactive coverage. If you’re on dialysis when you enroll in Medicare, coverage usually starts on your fourth treatment month. To apply for Medicare, you can:

  • Call Social Security at 1-800-772-1213 to begin your application
  • Visit Medicare.gov and start your application online anytime
  • Make an appointment at your local Social Security office to apply in person
  • Railroad Retirement Board (RRB) beneficiaries should call 1-877-772-5772 to apply for Medicare
  • Medicare Annual Enrollment Period Starts 10/15

    $0 monthly premium Medicare Advantage plans may be available in your state.

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Which Kidney Problems Count As ESRD?

You might know your kidneys aren’t working well, but don’t remember what the doctor said about your diagnosis. If any of these describe your condition, apply for Medicare as soon as you can:

  • You receive regular dialysis treatments now
  • You’re on the waiting list for a kidney transplant
  • Your kidneys no longer work, but you haven’t yet started regular dialysis treatments
  • You recently had a kidney transplant and are recovering
  • You currently receive monthly SSI or SSDI benefits for kidney failure or severe Chronic Kidney Disease (CKD)

Skipping the 24-Month Waiting Period for SSDI Beneficiaries

If you receive Social Security disability (i.e., SSDI payments), you normally must wait two years before Medicare coverage begins. ESRD patients can skip this required waiting period and get retroactive Medicare coverage for 12 months! Here’s what you should know about getting Medicare coverage faster:

  • Patients receiving dialysis treatments outside the home: Medicare coverage should start on the first day of the fourth month you undergo dialysis. For example: Your first dialysis treatment is March 1, 2021. That makes you eligible for Medicare coverage starting on June 1, 2021. If your dialysis treatments started a year ago, you can get retroactive Medicare coverage for the last eight months.

In-home dialysis training program participants: If a Medicare-certified training facility teaches you to do at-home dialysis treatments, good news! Medicare will cover your firs

Medicare Costs for Kidney Transplant & Dialysis Patients

You will automatically qualify for Medicare, and thankfully, federal law makes Part A coverage free for ESRD patients. In most cases, you’ll only pay $148.50 each month in premiums for Part B coverage. Your Part B deductible for 2021 should cost $203, then you’ll pay a $20 copay for things like:

  • Outpatient therapy
  • Durable Medical Equipment/DME (i.e., wheelchair, hospital bed, potentially your in-home dialysis equipment, etc.)
  • Doctor services, including hospital inpatient treatments

Final advice: Don’t skip out on opting into Medicare Part B coverage to save extra money. You’ll need both Medicare A and B coverage to get all the benefits that cover dialysis and kidney transplant services.

Medicare Annual Enrollment Period Starts 10/15

$0 monthly premium Medicare Advantage plans may be available in your state.