If you or a loved one has end-stage renal disease (ESRD)—the medical term for kidney failure, you may be eligible for Medicare. It’s a topic that your doctor or kidney care social worker should discuss with you. It’s important to have this discussion as soon as possible because each person’s situation is unique. Here are the basics on Medicare benefits for people with ESRD. Who Is Eligible for ESRD Medicare Benefits? Most people know Medicare as health insurance for those 65 and older. But you don’t have to be older than 65 for eligibility if you have ESRD. While it’s true that Medicare covers people with ESRD, not everyone is eligible. And it’s not always easy to understand. Here are the rules—you must have ESRD and meet one of the following criteria: You have met the work requirements for Medicare under Social Security, Railroad Retirement Board (RRB), or as a government employee. You are already getting or you are eligible for Social Security or Railroad Retirement benefits. You are the spouse or dependent child of someone who meets either the first or second criteria. Your social worker can help you sort through this. You can also contact Social Security or the RRB—if your benefits come from them—for assistance. What Does Medicare for ESRD Cover? Medicare coverage for ESRD includes Part A—hospital and other inpatient care—and Part B—outpatient care. You’ll need to enroll in both Part A and Part B to get the full benefits available to you. But remember that enrolling in Medicare is your choice. If you choose Medicare, you can enroll by contacting Social Security or visiting your local Social Security office. It’s important to note that when Medicare coverage starts, it covers all of your medical services, not only those related to ESRD. When Does Medicare Coverage Start? Figuring out when your coverage starts can be tricky. Medicare coverage usually starts on the first day of the fourth month of dialysis. In other words, there’s a 3-month waiting period once dialysis begins. But let’s say you’ve already been on dialysis for six months before you apply for Medicare benefits. The good news is that you’ve already completed the waiting period. Your coverage could start on the first month of dialysis if you are willing to use home dialysis. For coverage to start this early, you would need to take part in a home dialysis training program and eventually be able to dialyze yourself at home. There are also start date rules for kidney transplant. If you are having a kidney transplant, talk with your social worker for more information. What Is Coordination of Benefits? You may wonder how your dialysis will be covered during the 3-month waiting period for Medicare coverage to start. That’s where coordination of benefits (COB) becomes important. COB allows health plans to determine who pays for what. If you have a group health plan—such as through your or your spouse’s employer—you need to know about COB. Medicare coverage for ESRD has a 30-month COB period. During this period, your group health plan is the primary insurer and Medicare is a secondary insurer. It flips at the end of the COB period. Medicare becomes the primary insurer and your group health plan is a secondary insurer. You rely fully on your group health plan coverage during the 3-month waiting period for Medicare coverage to start. After that, you would have Medicare coverage on top of your regular coverage. The COB period starts the first month you are eligible for Medicare—regardless of whether you sign up for Medicare at that time. So let’s say that you’ve already been eligible and on dialysis for a year when you enroll in Medicare. This means you have 18 months left with your group health plan as the primary insurer. Then, Medicare becomes your primary insurer. Once you are eligible, you can enroll in Medicare any time from when your treatment starts through the COB period. It may make sense for some people to defer Medicare enrollment because of the way the COB period works. It depends on whether your group health plan has annual or lifetime limits on kidney services or not. Your social worker can help you determine whether deferment is beneficial for you. How Long Does Medicare Coverage Last? If you’re only on Medicare for dialysis, your coverage lasts for 12 months after your last month of dialysis or 36 months after the month in which you have a kidney transplant.