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Patient Resources Insurance & Financials


Federal Government Health Insurance

What is Medicare?

Medicare is a federal health insurance program that pays health care costs for eligible people who are

  • age 65 or older
  • under age 65 with certain disabilities and those who have received Social Security Disability Insurance (SSDI) for 2 years
  • of any age with end-stage renal disease (ESRD)—permanent kidney failure treated with a kidney transplant or blood-filtering treatments called dialysis

How can I get Medicare for kidney failure?

Visit Medicare.gov and search on “I have end-stage renal disease” to find information about whether you qualify for Medicare and how to sign up.

What health plans does Medicare offer?

Medicare has two main ways to get coverage—Original Medicare which includes Part A External link and Part B  or a Medicare Advantage Plan also called Part C. You can also choose to have prescription drug coverage through Medicare Part D

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 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

Learn more about Medicare benefits, rules, and coverage details at Medicare.gov 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

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

Medicare coverage will not end if you are eligible because of age or disability.

How does Medicare coordinate with other coverage?

Learn more about which insurance pays first if you have Medicare and other health coverage

Where can I get more information about Medicare’s kidney failure treatment coverage?

You can find more information about Medicare’s kidney failure treatment coverage from the following resources


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?

Medicaidprovides 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.

Find out whether you qualify for Medicaid in your state and learn how to apply at

Learn more at Medicaid.gov or call 1-877-267-2323 (TTY: 866-226-1819).

What is the Children’s Health Insurance Program (CHIP)?

CHIP 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 or your state’s Medicaid or CHIP agency

Learn more about CHIP at InsureKidsNow.gov or call 1-877-543-7669.
 


Other Federal Programs

What other state programs can help?

Medicare Savings Programs are programs in which your state may pay your Medicare premiums, deductibles, and/or coinsurance if you have a low income and few assets. How Medicaid works in U.S. territories varies

State Health Insurance Assistance Programs (SHIPs) give local advice about health insurance to people who have Medicare or who are eligible for Medicare. SHIP counselors can help you choose the best plan for your needs. Find a SHIP counselor at shiptacenter.org or call 1-877-839-2675.

State kidney programs provide financial help and other services to people with kidney disease. Talk with your dialysis or transplant clinic social worker or financial counselor to find out if your state has a kidney program.

State Pharmaceutical Assistance Programs (SPAPs) help pay for prescription medicines in certain states. Learn what’s available in your state with the SPAP online locator
 


Other State Programs

What other state programs can help?

Medicare Savings Programs are programs in which your state may pay your Medicare premiums, deductibles, and/or coinsurance if you have a low income and few assets. How Medicaid works in U.S. territories varies.

State Health Insurance Assistance Programs (SHIPs) give local advice about health insurance to people who have Medicare or who are eligible for Medicare. SHIP counselors can help you choose the best plan for your needs. Find a SHIP counselor at shiptacenter.org or call 1-877-839-2675.

State kidney programs provide financial help and other services to people with kidney disease. Talk with your dialysis or transplant clinic social worker or financial counselor to find out if your state has a kidney program.

State Pharmaceutical Assistance Programs (SPAPs) help pay for prescription medicines in certain states. Learn what’s available in your state with the SPAP online locator
 


Private Health Insurance

What types of private health insurance can help?

Some people with kidney failure use private health insurance to help pay for their health care

  • Group health insurance. People buy this kind of health insurance through their employer, union, or a family member’s employer or union.

    Group health plans pay for the first 30 months from the time you become eligible for Medicare for kidney failure. After that, a group plan can work with Medicare to help pay for costs that aren’t paid for by Medicare, such as copays, coinsurance, and deductibles. If you have or are eligible for group health insurance, you can contact the benefits administrator at the company or union that provides your insurance to find out what the plan covers and how it works with Medicare.
  • Individual health insurance. People buy this coverage for themselves and their families.
    • The Health Insurance Marketplace offers health insurance plans to people who are legally present in the United States and who don’t have any other health insurance options. You can find, compare, and buy individual insurance plans in most states—or connect to your state’s insurance marketplace—at HealthCare.gov

      You cannot enroll in a Health Insurance Marketplace plan if you already have Medicare. Some people choose to keep their Marketplace plan instead of enrolling in Medicare. You may pay more for Medicare later if you don’t enroll in Medicare when you first become eligible.
    • Insurance companies, agents, brokers, and online insurance stores are other ways to find and buy individual health insurance plans. Learn how to find a trustworthy insurance company at USA.gov or by calling 1-844-USA-GOV1 (1-844-872-4681).
  • Medigap, also called Medicare Supplemental Insurance. People buy this extra health insurance from a private company. Medigap plans help cover some costs that are not covered by Original Medicare, such as copays, coinsurance, and deductibles. If you’re 65, federal law protects your right to buy a Medigap plan. If you’re under 65 and are on dialysis External link, you may or may not be able to buy a Medigap policy from a licensed insurance company in your home state. Learn more online about Medigap rules, benefits, deadlines, and premiums

 

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