How to apply for ESRD Medicare

A practical guide to CMS-43, CMS-2728, CMS-40B, Social Security, and enrollment choices.

New to Medicare terms?Open the plain-language glossary.

What do I actually need to do?

For a new ESRD Medicare application, complete CMS-43, obtain CMS-2728 from your dialysis facility or transplant program, and send both to your local Social Security office. Keep copies for your records.

Find or contact Social Security

Find your local Social Security office by ZIP code. For general help, call 1-800-772-1213.

Key forms to know

CMS-43

Application for Part A (Hospital Insurance) and Part B (Medical Insurance) for People with End-Stage Renal Disease. You complete and sign it for a new ESRD Medicare application.

CMS-2728

End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration. Your dialysis facility or transplant provider completes it to document your treatment and diagnosis. Request a signed copy to submit with CMS-43.

CMS-40B

Request for Enrollment in Medicare Part B (Medical Insurance). Use it to request Part B only when you already have Medicare Part A. Submit it to your local Social Security office.

Already have Part A? Ask Social Security which Part B enrollment route applies to you before filing.

Consider your enrollment choices

You may enroll in Part A only, Parts A and B, or delay both when other coverage is available. Each choice affects costs, outpatient care, and possibly transplant medicines. Compare your plan before deciding.

Part A only

Part A helps with inpatient hospital care. It does not provide Part B coverage for most outpatient dialysis, doctor visits, and eligible transplant medicines. Before choosing Part A only, compare your current coverage and ask Social Security how and when you could add Part B.

Parts A and B

This gives you Medicare's hospital and medical coverage. Part B has a monthly premium, but it may help with Medicare-covered costs that your employer plan leaves during the 30-month coordination period. For a qualifying kidney transplant, Part A at the time of transplant and active Part B when prescriptions are filled are especially important for Part B coverage of anti-rejection medicines.

Wait to enroll in both

If you have employer or union group coverage, you may decide to delay both parts during the 30-month period. Medicare says this may make sense when that plan covers most costs, and delaying both parts in this situation does not by itself raise your Part B premium. Check when your other coverage could change, and plan your Medicare application before the group plan stops paying first. Waiting may also affect future transplant drug coverage.

New ESRD Medicare application

Medicare says you can enroll in Part B without a late-enrollment penalty when signing up based on ESRD. You may choose Part A only, but compare what Part B would cover and cost before deciding.

Already have Part A and want Part B later

Your enrollment period and any penalty depend on your Medicare history and other coverage. You may have to wait for the General Enrollment Period (January 1–March 31) if no other enrollment period applies. Ask Social Security to review your specific dates before assuming that a wait or penalty applies.

View timing and penalty detail

The Part B penalty depends on your specific enrollment history. Under Social Security's rules, months from a separate ESRD or disability entitlement before age 65 are not automatically carried into a later entitlement period; a penalty also resets at age 65. Ask Social Security to calculate your dates and premium. Compare ESRD enrollment paths and read Social Security's penalty rule.

Need a date before you apply?

Estimate your ESRD Medicare timeline, then confirm the actual effective dates with Social Security.