Medicare Coverage for Sufferers from Permanent Kidney Failure (ESRD) - dummies

Medicare Coverage for Sufferers from Permanent Kidney Failure (ESRD)

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Permanent kidney failure is a chronic medical condition that is known as end-stage renal disease (ESRD) in Medicare. It means that your kidneys have stopped working properly and you need either regular dialysis to keep them functioning or a kidney transplant. In this situation, you face no waiting period for Medicare but still have to meet certain conditions. You must either

  • Be fully insured — that is, have earned 40 work credits from your own work record to qualify for Social Security or railroad retirement benefits or worked as a government employee who qualified for Medicare through payroll taxes

  • Qualify as the spouse or dependent child of a person who is fully insured

The rules for when Medicare coverage starts depend on what kind of care you need (dialysis or transplant) and whether you also have coverage under an employer plan. If you receive Medicare on the basis of having ESRD only, the coverage continues until 12 months after you stop dialysis or 36 months after you’ve had a kidney transplant and no longer need dialysis.

But if you need to resume dialysis or you have another transplant, Medicare coverage begins again without any waiting period.

Because these rules are quite complicated and depend on your condition, call Social Security at the number listed earlier to find out how they apply to you.