People with ESRD must ensure that their insurance plan will cover hospital stays, doctors and other providers, dialysis (including home dialysis) and transplant (including living donors), supplies and equipment, and medications. Please speak with your dialysis social worker to discuss your insurance coverage at least twice a year to ensure that your needs are covered.
Health Insurance 101: Options for People with ESRD Home Dialysis Central has an article and comparison chart on Health Insurance 101: Options for People with ESRD. This is an excellent general overview of National programs.
Insurance Assistance Programs
RX Assist: website lists programs that help with paying for medications American Kidney Fund Health Insurance Premium Program (HIPP): American Kidney Fund pays Part B Medicare, Medigap, commercial, and COBRA premiums for dialysis patients who have insufficient income and savings. HIPP serves as a “last resort” source of financial assistance.
How to Apply for Medicare: Speak with your dialysis social worker. If you are eligible for Medicare because of ESRD, you can enroll in Part A and Part B by visiting your local Social Security office or by calling Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Note: If you are already enrolled in Medicare based on age or disability and you are already paying a higher Part B premium because you did not enroll in Part B when you were first eligible, the penalty will stop when you become entitled to Medicare based on ESRD. Call your local Social Security office to make an appointment to re-enroll in Medicare based on ESRD.
Medicare ESRD 30-Month Coordination of Benefits Period
If you’re eligible for Medicare only because of permanent kidney failure, your coverage usually can’t start until the fourth month of dialysis (also known as a “waiting period”). This means if you have coverage under an employer or union group health plan, that plan will be the only payer for the first 3 months of dialysis (unless you have other insurance). The waiting period for eligibility will start even if you haven’t signed up for Medicare. The same is true of the 30-month coordination period, which starts the first month you would be eligible to get Medicare because of permanent kidney failure (usually the fourth month of dialysis), even if you haven’t signed up for Medicare yet.
For more information, please see:
2015 Medicare Coverage of Kidney Disease and Transplant PDF (English|Spanish)