What is ESRD?

End Stage Renal Disease (ESRD) is the last stage of chronic kidney disease. Individuals in this stage need dialysis or a kidney transplant. Your kidneys are necessary to clean blood, manage fluids, balance chemicals, and control blood pressure. Dialysis can substitute for some of these functions, but not all. Dialysis is able to remove some waste from the blood and body, regulate certain chemicals, such as potassium and sodium, and help control blood pressure. Treatment is available either at home or in a hospital. Just make sure to check with your doctor about your options.

Speaking of options, there are two types of dialysis: hemodialysis and peritoneal. Hemodialysis uses an artificial kidney outside the body to cleanse the blood. The physician makes an entrance into the patient’s blood vessels by way of minor surgery. Peritoneal dialysis cleans the blood inside the body. The doctor places a catheter in the abdominal cavity. Slowly, dialysate fills the abdominal cavity. Dialysate draws out extra fluid and waste from the body. Kidney dialysis is expensive, but there are many options for people with ESRD. For instance, one option is Medicare.

You could be entitled to Medicare benefits if you are under 65 and have ESRD. These benefits will apply to all covered services, not those only related to kidney failure. The Medicare coverage is the secondary payer to group health plans, and group plan coverage provided by COBRA. Group Health Plans can not limit benefits, charge higher premiums, or terminate coverage because of an individual’s ESRD.

When Medicare Coverage Begins

When someone does enroll in Medicare on the basis of ESRD, Medicare coverage typically begins on the fourth month of dialysis. However, coverage can start as early as the first month of dialysis if the beneficiary meets certain circumstances, such as:

  • The patient takes part in a Medicare-approved training program that teaches them how to do self-dialysis treatment at home.
  • The beneficiary begins the home dialysis training before the third month of dialysis
  • The patient finishes training and administers treatment at home

Medicare coverage can also start the month the beneficiary is admitted for a kidney transplant or for services needed before the transplant. In this case, the transplant must take place within the same month or the two following months. If the transplant is delayed more than two months after admission to the hospital, Medicare coverage can begin two months before the month of transplant.

When Medicare Coverage Ends

Medicare coverage for ESRD will stop after one of the following circumstances occurs:

  1. One year after the beneficiary stops dialysis treatments
  2. Three years after the beneficiary has a kidney transplant

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