How does Medicare work if I have kidney failure (ESRD)?

Who can get Medicare with kidney failure?

End-Stage Renal Disease (ESRD) is permanent kidney failure that requires a regular course of dialysis or a kidney transplant. If you have ESRD, you can get Medicare no matter how old you are if all of these apply:

• Your kidneys no longer work.
• You need regular dialysis or have had a kidney transplant.
• You've worked the required amount of time under Social Security, the Railroad Retirement Board (RRB) or as a government employee; or you already get or are eligible for Social Security or Railroad Retirement benefits; or you're the spouse or dependent child of a person who meets either of those requirements.

How do I sign up, and when does Medicare coverage start?

If you have ESRD and want Medicare, you need to sign up for it. Your dialysis facility completes an End-Stage Renal Disease Medical Evidence Report (Form CMS-2728), asks you to sign it and submits it to Social Security; you then sign up for Part A and Part B through your local Social Security office or by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You need both Part A and Part B to get the full Medicare benefits for dialysis and kidney transplant services. If you're approved because of ESRD, you can sign up for Part B without a late enrollment penalty.

On dialysis, Medicare usually starts on the first day of the fourth month of treatment, and that 4-month waiting period runs even if you haven't signed up yet: start dialysis on July 1 and coverage begins October 1. Coverage can start in the first month of dialysis if you take part in a home dialysis training program at a Medicare-certified facility during the first 3 months, your doctor expects you to finish training and do your own treatments at home, and you keep up regular dialysis. For a kidney transplant, coverage can start the month you're admitted to a Medicare-certified hospital for the transplant or care you need before it, if the transplant happens that month or within the next 2 months; if it's delayed longer, coverage starts 2 months before the transplant. If you sign up late, coverage can go back up to 12 months before the month you apply.

What does Medicare cover for dialysis and kidney transplants?

Medicare generally covers 3 hemodialysis treatments (or equivalent peritoneal dialysis) a week. Part A covers inpatient dialysis in a hospital and the inpatient hospital care for a kidney transplant, including the kidney registry fee, tests for you and a potential donor, finding a kidney if there's no donor, and the full cost of care for your kidney donor. Part B covers:

• Outpatient dialysis and doctors' services in a Medicare-certified dialysis facility or at home, including dialysis for acute kidney injury.
• Home dialysis training for you and the person helping you, home dialysis equipment and supplies, and certain home support services.
• Drugs for outpatient and home dialysis, such as heparin and erythropoiesis-stimulating agents (like epoetin alfa) to treat anemia from ESRD, plus phosphate binders.
• Doctors' services for kidney transplant surgery, before, during and after it, and for your donor during their hospital stay.
• Immunosuppressive drugs to prevent organ rejection, if Medicare helped pay for your transplant.
• Ambulance trips from home to the nearest dialysis facility only when traveling any other way could endanger your health.

What do I pay with Medicare for ESRD care?

For dialysis in a facility, home dialysis training and outpatient doctors' services, you pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026), and you keep paying your monthly Part B premium. Inpatient dialysis is covered by Part A after the hospital inpatient deductible. For a transplant, you pay 20% of the Medicare-approved amount for Part B services after the deductible, nothing for Medicare-approved laboratory tests, and nothing for your donor's care.

Part B doesn't cover drugs for your other health conditions, like high blood pressure, and Medicare drug coverage (Part D) helps with the costs of those drugs; see how Medicare drug coverage works. Medicare doesn't cover paid dialysis aides for home dialysis, pay you lose during home dialysis training, a place to stay during treatment, or blood for home dialysis unless it's part of a doctor's service.

How does Medicare work with my employer plan if I have ESRD?

If you have employer or union group health plan coverage, that plan is the only payer for the first 3 months of dialysis, before Medicare starts, unless you have other coverage. After you become eligible for Medicare because of ESRD, a 30-month coordination period begins: your group health plan pays first and Medicare pays second. At the end of the 30 months, Medicare pays first for all Medicare-covered services, and there's a new 30-month coordination period each time you sign up for Medicare based on kidney failure.

You don't have to sign up for Medicare if you have a group health plan. If the plan pays most or all of your costs, you may want to delay signing up until the 30-month coordination period is over, and your Part B premium won't be higher because you waited in this situation. Sign up as soon as possible if your plan's benefits drop or end. Because Medicare covers immunosuppressive drugs only in specific circumstances, find out about transplant drug coverage before you decide.

Can I choose Medicare Advantage or a drug plan with ESRD?

Yes. People with ESRD can choose Original Medicare or a Medicare Advantage plan. Medicare Advantage plans must cover what Original Medicare covers, and some offer extra benefits; rules and costs vary by plan. In many cases you'll need to use providers in the plan's network, so before you join, check that your dialysis facility, kidney doctor and any transplant specialist you may need are in the plan's network, and check the plan's prior authorization rules if you're on a transplant waiting list. See how Original Medicare and Medicare Advantage differ.

Your first chance to join a Medicare drug plan is the 7-month period that begins 3 months before the month you're eligible for Medicare and ends 3 months after it. Drug coverage starts when your Medicare starts, or the month after you ask, whichever is later.