Special Rules for People with End-Stage Renal Disease
If you have End-Stage Renal Disease (ESRD) and you are in the
Original Medicare Plan, you may join a
Medicare Prescription Drug Plan (Part D), but you usually can't join a
Medicare Advantage Plan. However, if you are already in a Medicare Advantage Plan, you can stay in it or join another plan offered by the same company. If you've had a successful kidney transplant,
you may be able to join a Medicare Advantage Plan.
In 2020, if you have ESRD and a Medicare Advantage Plan and the plan leaves Medicare or no longer provides coverage in your area, you have a one-time right to join another Medicare Advantage Plan. You don't have to use your one-time
right to join a new plan immediately. If you change directly to the Original Medicare Plan after your plan leaves or stops providing coverage, you will still have a one-time right to join a Medicare Advantage Plan at a later date
as long as the plan you choose is accepting new members.
However the ESRD rule is changing. Starting in 2021, people with End-Stage Renal Disease can join Medicare Advantage plans without these restrictions.
Read more at Q1FAQ.com/75.
Note: If you have ESRD and Original Medicare, you may join a Medicare Prescription Drug Plan.
You may also be able to join a Medicare
Special Needs Plan for people with
ESRD if one is available in your area. For more information, visit www.medicare.gov and view the booklet "Medicare Coverage of Kidney Dialysis and Kidney Transplant Services." To compare dialysis facilities in your area, visit www.medicare.gov on the web. Select "Search Tools" at the top of the page. Then select "Compare Dialysis Facilities in Your Area." Or, call 1-800-MEDICARE
(1-800-633-4227) for more information about ESRD and Medicare plans.
TTY users should call 1-877-486-2048.