What health plans does Medicare offer?
Medicare has two main ways to get coverage—Original Medicare External link, which includes Part A External link and Part B External link, or a Medicare Advantage Plan External link, also called Part C. You can also choose to have prescription drug coverage through Medicare Part D External link.
Most people with kidney failure are not allowed to join a Medicare Advantage plan. However, beginning in 2021, the 21st Century Cures Act will allow people with ESRD to choose a Medicare Advantage plan instead of Original Medicare. Medicare Advantage plans may limit where you get care, but they cap out-of-pocket costs. With Original Medicare, there is no cap on out-of-pocket costs, but you can get care anywhere that Medicare is accepted.
You can find out more about the Medicare health plans by visiting Medicare.gov External link and searching on “ESRD,” then clicking on “Signing up for Medicare if you have ESRD.”
Other Medicare health plans are available that have special rules or are for specific groups of people. Medicare offers more information about these alternate plans online External link.
Learn more about Medicare benefits, rules, and coverage details at Medicare.gov External link or by calling 1-800-MEDICARE (1-800-633-4227; TTY: 1-877-486-2048).
When does Medicare coverage start for people with ESRD?
If kidney failure is the only reason you are signing up for Medicare, your Medicare start date will depend on the type of kidney failure treatment you receive. Find out more about when your Medicare coverage may start External link.
When does Medicare coverage end for people with ESRD?
If kidney failure is the only reason you have Medicare, your coverage end date will depend on whether you had a kidney transplant or dialysis treatment. Learn more about when your Medicare coverage will end External link.
Medicare coverage will not end if you are eligible because of age or disability.
Joint federal-state programs
You may also be able to get help paying for your kidney failure treatment from one or more programs that are run jointly by the Federal Government and state governments, including Medicaid and the Children’s Health Insurance Program (CHIP).
What is Medicaid?
Medicaid External link provides free or low-cost health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Each state runs its own Medicaid program based on rules set by the Federal Government. Medicaid may pay for services that Medicare does not.
What is the Children’s Health Insurance Program (CHIP)?
CHIP External link offers free or low-cost Medicaid to children whose parents earn too much for Medicaid but not enough to pay for a private health plan. CHIP is run by the states, based on federal rules. In some states, CHIP may cover pregnant women and parents. Find out if your family members qualify for CHIP through Healthcare.gov External link or your state’s Medicaid or CHIP agency External link.
Help paying for medicines
Talk with your health care team if you have trouble paying for your medicines, including asking about cheaper options. Your team may suggest other ways to cut your costs, such as using mail-order pharmacies or contacting local aid programs.
Key Terms
Some terms listed here have many meanings; only those meanings that relate to the financial and medical aspects of kidney failure and its treatment are included.
coinsurance: an amount a person may still need to pay after a deductible for health care. The amount is most often a percentage, such as 20 percent.
coordination period: if a person has more than one health plan, a coordination period is used to figure out which plan pays first and for how long. For example, if a person has an employer group plan and Medicare, the employer group plan is the first payer for the first 30 months the person is eligible for Medicare.
copay (or copayment): an amount a person may have to pay for health care. A copay is often a set fee. A person might pay $10 or $20 for a health care provider visit or prescription.
deductible: an amount a person must pay for health care or prescriptions before the health plan(s) will pay.
network: a group of health care providers that gives members a discount. Some plans pay for health care and prescriptions only if received from a network provider.
out of network: health care providers who are not in a plan’s network. In some health plans, health care and prescriptions cost more if received from these providers.
premium: an amount a person must pay periodically—monthly or quarterly—for Medicare, another health plan, or drug plan coverage.
social worker: a person who is trained to help people solve problems in their daily lives, especially people with disabilities or low incomes. A social worker may help with financial, employment, and emotional issues. Dialysis clinics and transplant centers must have a social worker with a Master of Social Work degree to help their patients.
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