Kidney Disease and Medicare Drug Coverage

Adapted from Medicare Coverage of Kidney Dialysis and Kidney Transplant Services, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Medicare drug coverage (Part D)

What Medicare covers

Medicare Part B covers transplant drugs after a covered transplant (go to pages 20–21) and most of the drugs you get for dialysis. However, Part B doesn’t cover drugs for other health conditions you may have, like high blood pressure. Medicare drug coverage (Part D) offers drug coverage to help you with the costs of your drugs that Part B doesn’t cover.

Medicare drug coverage won’t cover drugs you can get under Part B, like immunosuppressive drugs under the conditions discussed on pages 20–21. However, if you don’t meet the conditions on pages 20–21, you may be able to get coverage of your immunosuppressive drugs by joining a Medicare Part D drug plan.

Private companies approved by Medicare offer Part D drug coverage. There are 2 ways to get Medicare drug coverage (Part D):

• Medicare drug plans that add coverage to Original Medicare or certain types of Medicare health plans.
• Medicare Advantage Plans with drug coverage. You must have Medicare Part A and Part B to join a Medicare Advantage Plan. To learn more, visit Medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan.

Note: If you join a Medicare Advantage Plan with drug coverage, you'll get your drug coverage through your plan, and you can't join a separate Medicare drug plan.

Most drug plans charge a monthly premium that varies by plan. You pay this and the Part B premium. If you’re in a Medicare Advantage Plan with drug coverage, the monthly premium may include an amount for drug coverage. Your costs will vary depending on which drugs you use and which drug plan you choose.

When can I join Medicare drug coverage (Part D)?

If you become eligible for Medicare because of ESRD, your first chance to join Medicare drug coverage (Part D) will be during the 7-month period that begins 3 months before the month you’re eligible for Medicare and ends 3 months after the month you’re eligible (called your Initial Enrollment Period).

Your Medicare drug coverage will start the same time your Medicare Part A and/or Part B coverage starts. If you join a Medicare drug plan after your Medicare Part A and/ or Part B coverage starts, it will be effective the first day of the month after you join.

If you don’t join when you’re first eligible, or during a Special Enrollment Period, you can join during Open Enrollment (October 15–December 7 each year). Your coverage will begin on January 1 of the next year. If you join after your Initial Enrollment Period is over, and there was a period of 63 continuous days or more during which you didn’t have Part D or other creditable prescription drug coverage, you may have to pay a late enrollment penalty (which is added to your monthly premium).

This amount increases the longer you go without Part D or creditable coverage. You’ll have to pay this penalty as long as you have Medicare drug coverage. However, if you get Extra Help, you don’t have to pay a late enrollment penalty.

Visit Medicare.gov/drug-coverage-part-d for more information about Medicare drug coverage. You can also visit shiphelp.org to contact your local State Health Insurance Assistance Program (SHIP) for free personalized health insurance counseling.

Extra Help

Extra Help is a program that helps people with limited income and resources pay Medicare Part D drug costs. If you qualify, you’ll get help paying for your Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments or coinsurance.

In general, to qualify for Extra Help, your yearly income in 2025 must be below $23,475 ($31,725 for a married couple), and your resources must be below $17,600 ($35,130 for a married couple). These amounts may change in 2026.

If you live in Alaska or Hawaii, or pay more than half of the living expenses of dependent family members, your income limits are higher.

Resources include things like your savings and stocks (but not home), one car, household items, burial plot, up to $1,500 for burial expenses (per person), and life insurance policies.

Note: If you live in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, you’re not eligible for the same Extra Help described here. Visit Medicaid.gov/about-us/beneficiary-resources/index.html#statemenu to get the contact information for your Medicaid office for more information about these programs.

How can I apply?

Some people with Medicare automatically qualify for Extra Help and will get a letter from Medicare. Others will need to apply.

If you don’t get a letter stating that you automatically qualify, visit SSA.gov/extrahelp to apply. After you apply, you’ll get a letter in the mail letting you know if you qualify and what to do next. Even if you don’t qualify for Extra Help, you might consider joining a Medicare drug plan if you don’t have other creditable drug coverage.

If you qualify for Extra Help, and don’t join a Medicare drug plan, Medicare will automatically enroll you in a plan. You can “opt out” of being automatically enrolled. Medicare will send you a letter letting you know what plan it will enroll you in and when your coverage begins. Check if the plan you’re being enrolled in covers the drugs you use, and if you can go to the pharmacies you want. If not, you can change plans. People who qualify for Extra Help can join, switch, or drop a Medicare drug plan once a month.

Source and further reading

Medicare Coverage of Kidney Dialysis and Kidney Transplant Services — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.