Qualifying for Medicare Through End-Stage Renal Disease

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 basics

What’s Medicare?

Medicare is federal health insurance for:

• People 65 and older
• People under 65 with certain disabilities
• People with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)

What does Medicare cover?

Part A – Hospital Insurance

Helps cover:

• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care

Part B – Medical Insurance

Helps cover:

• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D – Drug Coverage

Helps cover the cost of prescription drugs (including many recommended shots or vaccines). Part D also helps you with drug costs that Part B doesn’t cover.

Plans that offer Medicare drug coverage (Part D) are run by private insurance companies that follow rules set by Medicare. Different plans cover different drugs, but plans must cover a wide range of medically necessary drugs that people with Medicare take.

For more details about what Medicare covers, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Medicare plan choices

There are 2 main ways to get Medicare: you can choose between Original Medicare or join a Medicare Advantage Plan.

If you have ESRD and choose Original Medicare

You can go to any doctor or supplier that accepts Medicare (and new patients), or any participating hospital or other facility.

You pay a set amount for your health care (deductible) before Medicare starts paying. Then, Medicare pays its share, and you pay your share (coinsurance or copayment) for covered services and supplies.

When you have Original Medicare, you can add Medicare drug coverage (Part D) by joining a Medicare drug plan. Go to page 23.

If you have ESRD & choose a Medicare Advantage Plan

Medicare Advantage Plans are a type of Medicare health plan offered by a private insurance company that contracts with Medicare to give all of your Part A and Part B benefits. Most Medicare Advantage Plans also offer Part D drug coverage. Medicare Advantage Plans must cover all of the services that Original Medicare covers. Some plans may offer extra benefits that Original Medicare doesn’t cover, like vision, hearing, and dental services. Out-of-pocket costs vary in each plan.

Once you have Medicare Part A and Part B, you can join a Medicare Advantage Plan. Visit Medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan to learn more.

Important: In many cases, you can only use health care providers who are in the Medicare Advantage Plan’s network and service area. Before you join, check with your providers and the plan you’re considering to make sure the providers you currently go to (like your dialysis facility or kidney doctor), or want to visit in the future (like a transplant specialist), are in the plan’s network. If you’re already in a Medicare Advantage Plan, check with your providers to make sure they’ll still be part of the plan’s network next year. To learn more about a specific Medicare Advantage Plan, contact the plan, or visit Medicare.gov/plan-compare.

If you join a Medicare Advantage Plan within the first 3 months and you have both Medicare Part A and Part B, you can use the Medicare Advantage Open Enrollment Period (January 1–March 31) to change to a different Medicare Advantage Plan or switch back to Original Medicare. If you join a Medicare Advantage Plan during the Open Enrollment Period (October 15–December 7), you can also use the Medicare Advantage Open Enrollment Period to change to a different Medicare Advantage Plan or switch back to Original Medicare (depending on which coverage works best for you).

To learn more about types of Medicare Advantage Plans, visit Medicare.gov/health-drug-plans/health-plans/your-coverage-options/compare.

For more information about your Medicare plan choices, look at your most recent “Medicare & You” handbook or visit Medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227) to get more information. TTY users can call 1-877-486-2048.

Getting Medicare with ESRD

You can get Medicare no matter how old you are, if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of these applies to you:

• You’ve worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
• You’re already getting or are eligible for Social Security or RRB benefits
• You’re the spouse or dependent child of a person who meets either of the requirements above

You must also file an application with the Social Security Administration and meet any waiting periods that apply.

Note: If you qualify for Medicare Part A, you can also get Medicare Part B. Most people must pay a monthly premium for Part B. Go to page 29. Signing up for Part B is your choice, but you’ll need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services.

If you don’t qualify for Medicare, you may be able to get help from your state to pay for your dialysis treatments. Go to page 36.

Visit SSA.gov for more information about the required amount of time needed under Social Security, the RRB, or as a government employee to be eligible for Medicare based on ESRD.

If your child has ESRD

Your child can be covered if you or your spouse have worked the required amount of time under Social Security, the RRB, or as a government employee. Your child can also be covered if you, your spouse, or your child gets Social Security or RRB benefits, or is eligible to get those benefits.

Medicare can help cover your child’s medical costs if your child needs regular dialysis because their kidneys no longer work, or if they had a kidney transplant.

Visit Medicare.gov/basics/children-and-end-stage-renal-disease for more information. To sign your child up for Medicare, or to get more information about eligibility, visit your local Social Security office.

How to sign up for Medicare

If you’re eligible for Medicare because of ESRD, you can visit your local Social Security office to sign up.

Once you have Medicare, you’ll need to choose how you get your coverage. Go to pages 2–4. For more information on your coverage options, visit Medicare.gov.

Note: If you already have Medicare because of age or disability, and you’re currently paying a Part B late enrollment penalty, you'll need to sign up again for Medicare (because of ESRD) to stop paying the penalty. Visit your local Social Security office to make an appointment to re-enroll in Medicare based on ESRD.

When Medicare coverage begins

Eligibility for Medicare coverage because of ESRD works differently than other types of Medicare eligibility. If you’re eligible for Medicare because of ESRD and don’t sign up right away, your coverage could be retroactive up to 12 months before the month you apply, but no earlier than the date you first became eligible. Retroactive coverage means you may be covered for some costs that occurred in the past.

Example: If you become eligible for Medicare based on ESRD in February, but don’t sign up for Medicare until November, your Medicare coverage will backdate to February.

For more information, visit Medicare.gov/basics/end-stage-renal-disease or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

If you’re on dialysis

When you sign up for Medicare because of ESRD and you’re on dialysis, Medicare coverage usually starts on the first day of the fourth month of your continuous dialysis treatments (called a “waiting period”). For example, if you start dialysis on July 1, your coverage will begin on October 1.

For some, Medicare coverage can begin as early as the first month of a regular course of dialysis treatments if you meet both of these conditions:

• You participate in a home dialysis training program that a Medicare-certified training facility offers during the first 3 months of your regular course of dialysis.
• Your doctor expects you to finish training and be able to do your own dialysis treatments.

Important: Medicare won’t cover surgery or other services needed to prepare for dialysis (like surgery for blood access (fistula)) before Medicare coverage begins. However, if you complete home dialysis training, your Medicare coverage will start the month you begin regular dialysis, and Medicare could cover these services.

If you’re already getting Medicare because of age or disability, Medicare will cover physician-ordered fistula placement or other preparatory services before dialysis begins.

If you’re getting a kidney transplant

Medicare coverage can begin the month you’re admitted to a Medicare-certified hospital for a kidney transplant (or for health care services that you need before your transplant) if your transplant takes place in that same month or within the next 2 months.

Example: Mr. Green will be admitted to the hospital on March 11 for his kidney transplant. His Medicare coverage will begin in March. If his transplant is delayed until April or May, after his hospital admission, his Medicare coverage will still begin in March.

If your transplant is delayed more than 2 months after you’re admitted to the hospital (for the transplant or for health care services you need before your transplant), Medicare coverage can begin 2 months before your transplant.

When Medicare coverage ends

If you’re eligible for Medicare only because of ESRD your Medicare coverage will end:

• 12 months after the month you stop dialysis treatments
• 36 months after the month you have a kidney transplant

Your Medicare coverage will resume if:

• You start dialysis again, or you get a kidney transplant within 12 months after the month you stopped getting dialysis.
• You start dialysis or get another kidney transplant within 36 months after the month you get a kidney transplant.

Note: Medicare offers a benefit that helps pay for immunosuppressive drugs beyond 36 months after your kidney transplant (when Medicare coverage generally ends), if you don’t have certain types of health coverage. This benefit only covers immunosuppressive drugs and no other items or services. It isn’t a substitute for full health coverage. Visit Medicare.gov/basics/end-stage-renal-disease to learn more.

How Medicare works with employer or union group health plan coverage

If you’re eligible for Medicare only because of permanent kidney failure, your coverage usually can’t start until after the waiting period. This means if you have coverage through an employer or union group health plan, that plan will be the only payer for your first 3 months of dialysis (unless you have other coverage).

If your employer or union plan doesn’t pay all costs for dialysis, you may have to pay some of the costs. You may be able to get help paying these costs. Go to page 36.

Once you become eligible for Medicare because of permanent kidney failure (usually the fourth month of dialysis), there will still be a period of time, called a “coordination period,” when your employer or union group health plan will continue to pay your health care bills.

If your plan doesn’t pay 100% of your health care bills, Medicare may pay some of the remaining costs during a coordination period. This is called “coordination of benefits,” under which your plan “pays first” and Medicare “pays second.” During this time, Medicare is called the secondary payer (the insurance policy, plan, or program that pays second on a claim for medical care). This coordination period lasts for 30 months.

The 30-month coordination period

The 30-month coordination period starts the first month you would be eligible to get Medicare because of permanent kidney failure (usually the fourth month of dialysis), even if you haven’t signed up for Medicare yet.

Example: If you start dialysis and are eligible for Medicare in June, the 30-month coordination period will start September 1, the fourth month of dialysis, even if you don’t have Medicare.

If you participate in home dialysis training or get a kidney transplant during the 3-month waiting period, the 30-month coordination period will start earlier. During this 30-month period, Medicare will be the secondary payer.

Important: If you have employer or union group health plan coverage, tell your health care provider right away. This is very important to make sure that your services are billed correctly. At the end of the 30-month coordination period, Medicare will pay first for all Medicare-covered services. Your employer or union group health plan coverage may still pay for services Medicare doesn't cover. Check with your plan’s benefits administrator for more information.

There’s a separate 30-month coordination period each time you sign up for Medicare based on permanent kidney failure. For example, if you get a kidney transplant that continues to work for 36 months, your Medicare coverage will end (unless you have Medicare based on your age or disability).

If after 36 months you sign up for Medicare again because you start dialysis or get another transplant, your Medicare coverage will start right away. There will be no 3-month waiting period before Medicare begins to pay. However, there will be a new 30-month coordination period if you have employer or union group health plan coverage.

Do I have to get Medicare if I already have an employer or union group health plan?

No, but think carefully about this decision. If you get a kidney transplant, you’ll need to take immunosuppressive drugs for the rest of your life, so it’s important to know if they’ll be covered. Medicare Part B only covers immunosuppressive drugs in specific circumstances. Go to page 21.

Note: If you don’t meet the conditions for Part B coverage of immunosuppressive drugs, you may be able to get Part D drug coverage. Go to pages 22–24 to learn more.

If your group health plan coverage has a yearly deductible, copayment, or coinsurance, signing up for Medicare Part A and Part B could help pay those costs during the coordination period. If your group health plan coverage will pay for most or all of your health care costs (like if it doesn’t have a yearly deductible), you may choose to delay signing up for Part A and Part B until the 30-month coordination period is over.

If you delay enrollment in Medicare, you won’t have to pay the Part B premium for coverage you don’t need yet. After the 30-month coordination period, you should sign up for Part A and Part B. Your Part B premium won’t be higher because you delayed your enrollment while you have employer or union group health plan coverage based on your or your spouse’s current employment. If your group health plan benefits are decreased or end during the coordination period, you should sign up for Part A and Part B as soon as possible.

For more information about how employer or union group health plan coverage works with Medicare:

• Get a copy of your plan’s benefits booklet.
• Call your benefits administrator, and ask how the plan pays when you have Medicare.

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.