ESRD & Medicare

Medicare provides excellent and comprehensive health insurance to millions including Americans with ESRD. In 2021, there are even positive changes in Medicare for those with ESRD.

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If you have ESRD, you will be eligible for Medicare. You do not have to be 65. Because you will not be automatically enrolled you will need to contact your social security office to enroll. At that time you will enroll in Medicare Part A, your hospital insurance, and Medicare Part B, your outpatient insurance. There is usually no charge for Medicare Part A, but you may have to pay a monthly premium for Medicare Part B. This is determined by your income. You may qualify for special programs designed to help you pay for Medicare Part B.

Original Medicare covers your inpatient and outpatient care. Generally speaking Medicare will cover about 80% of the costs, leaving you with about 20%. Because of these out of pocket costs, the Medicare Part A deductible, and a need for prescription drug coverage, many people look for a Medicare Supplement Plan or a Medicare Advantage Plan. These plans cover the gaps of Original Medicare and help to limit your out of pocket spending. As of 2021, you cannot be denied a Medicare Advantage plan based on ESRD. So you can choose from either an Advantage Plan or a Supplement Plan to fulfill your specific needs. Medicare Advantage and Medicare Supplement Plans are actually drastically different, so please contact a licensed broker to find the plan that best suits your needs. You can find available plans on medicare.gov.

Original Medicare does NOT cover most prescription drugs. Original Medicare will, however, cover transplant drugs and drugs needed for dialysis. However, should you have any other prescription drug needs, you will need either a Medicare Advantage Plan which includes prescription drug coverage or Medicare Part D. We strongly encourage you to enroll in some type of prescription drug coverage because without it, your prescriptions can be quite costly. There are extra help programs available for Medicare Part D to help offset costs.

Many who are eligible for Medicare due to ESRD are also eligible for Medicaid. Medicaid eligibility is determined by the federal poverty guide, household size and state. Many states have adopted expanded Medicaid programs with medically needy programs. If your medical needs are large enough you may be able to spend down your income therefore making you eligible for Medicaid. If you are eligible for Medicaid & Medicare, you may want to look into a dual special needs plan (aka DSNP). DSNPs are a type of Medicare Advantage Plan (Medicare Part C) which offer the full benefits of Medicare Part A, Medicare Part B, Medicaid and prescription drug coverage.


If you have any further questions, please feel free to contact us here at iHealthBrokers at 888-410-0344 or https://ihealthbrokers.com/


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