Can I get Medicare if I have advanced kidney disease?

Another option: You can qualify as the spouse or dependent child of a person who has earned enough work credits. Your State Health Insurance Assistance Program (SHIP) can help with Medicare enrollment and coverage questions.

People with ESRD aren’t required to sign up for SSDI to receive Medicare coverage, but they need to take steps to enroll. You can contact the Social Security Administration to start the Medicare application process.

When does Medicare coverage for kidney disease take effect?

If you’re 65 or older, you can receive kidney-related benefits from Medicare anytime after you enroll.

For new enrollees younger than 65, Medicare coverage begins based on the dialysis or kidney transplant you need:

• If you’re using a dialysis center, Medicare coverage can start the first day of the fourth month of dialysis treatment and continues for up to 12 months after you stop dialysis.

• If you’re in a home dialysis program, your coverage can begin the first month of dialysis and continue for up to 12 months after you stop dialysis. 

• If you’re getting a kidney transplant, you can generally receive Medicare benefits the month you’re admitted to the hospital. Coverage usually continues for 36 months after you’ve had the transplant and no longer need dialysis.

• If you need to resume dialysis or have another transplant, coverage will begin again without a waiting period. If you’re also eligible for Medicare because of another disability or because you’re 65 or older, your coverage won’t end.

• If you’re a transplant recipient and have met your 36-month coverage limit, you can now sign up for the Medicare Part B immunosuppressive drug benefit, which became available on Jan. 1, 2023. With this coverage, Medicare Part B continues to cover your transplant immunosuppressive drugs at 80 percent if you have no other insurance coverage that contains a benefit for anti-rejection drugs. The standard monthly premium for this benefit is $103 in 2024; high earners pay more. This program only covers immunosuppressive drugs, not other Part B coverage.

New rules for Medicare Advantage and kidney disease

People with end-stage renal disease can now receive coverage through either original Medicare or a private Medicare Advantage plan. Before the 21st Century Cures Act of 2016 opened the door to coverage beginning Jan. 1, 2021, people with kidney failure couldn’t enroll in Medicare Advantage.

At age 65, you can sign up for Medicare Advantage when you first enroll in Medicare parts A and B. You can also sign up or switch plans during open enrollment from Oct. 15 to Dec. 7, with new coverage starting Jan. 1.

If you’re younger than 65, you can enroll in Medicare Advantage when you first become eligible for Medicare under ESRD rules after signing up for parts A and B. You can also sign up for Medicare Advantage or switch plans during open enrollment each year. 

Before choosing a Medicare Advantage plan, make sure your care team, including your primary care physicians, dialysis provider, nephrologist, transplant center and other specialists like cardiologists and endocrinologists, is part of the plan’s network. If you’re pursuing a kidney transplant, find out how the plan will cover Part B medications, such as those to prevent rejection of the transplant.

Some Medicare Advantage special needs plans offer coverage for people with ESRD. These plans provide services to support dialysis, help manage care for kidney patients, and may include a dedicated kidney care team.

For more information about coverage for ESRD under original Medicare and Medicare Advantage, see Medicare.gov’s Medicare Coverage of Kidney Dialysis & Kidney Transplant Services.

Keep in mind

If you’re younger than 65 and qualify for Medicare because of ESRD, find out about your state’s rules on Medicare supplement policies, also called Medigap, before deciding between original Medicare and Medicare Advantage. These rules may be a deciding factor in your choice.

Even though you can buy a Medigap policy within six months of signing up for Medicare Part B at age 65, regardless of preexisting conditions, rules for younger people vary by state. These plans can help pay out-of-pocket costs for parts A and B of original Medicare.

Some states don’t have guaranteed issue rights for Medigap if a Medicare beneficiary is younger than 65, which makes it difficult to qualify for coverage with a preexisting condition such as ESRD. Contact the SHIP program in your area to learn more about your state’s rules.

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