Questions and answers
Common ESRD Medicare questions
Quick answers with links to the full explanation and official sources.
When Medicare can begin
Does Medicare start immediately when dialysis begins?
Usually not for in-center dialysis. ESRD Medicare generally begins in month four; qualifying home dialysis training or transplant can change the date.
Can home dialysis allow an earlier start?
Yes, when training begins during the first three dialysis months and all Medicare conditions are met.
Does a transplant change the start date?
It can. A qualifying hospital admission or transplant month may establish an earlier entitlement point.
Insurance and who pays first
What is the 30-month coordination period?
It is the period used to decide payment order between Medicare and employer, union, or COBRA coverage. It can begin before you enroll.
Will Medicare always pay first after 30 months?
Only if Medicare is active and entitlement continues, subject to your coverage history. ESRD-only Medicare may end before that date.
What if I already had Medicare because of age or disability?
The earlier Medicare basis can change which group-plan rule applies. Confirm actual dates and payment order.
What if I have Marketplace, Medicaid, or VA coverage?
Each follows different rules. A Marketplace plan does not end automatically; Medicaid usually pays after Medicare; VA and Medicare do not pay the same claim.
When Medicare may end
When can ESRD-only Medicare end?
Generally 12 months after the month dialysis stops without transplant, or 36 months after the month of a successful transplant.
What if dialysis starts again or I have another transplant?
It may continue or resume ESRD coverage. Whether a new 30-month period applies depends on whether earlier entitlement ended.
Read more about returning to dialysis or another transplant →
Applying and medications
How do I apply for ESRD Medicare?
Use CMS-43 and obtain CMS-2728 from your treatment provider. Submit them to Social Security.
What if I have Part A but not Part B?
Part B covers important outpatient services. Ask Social Security when and how you can enroll before choosing or continuing Part A only.
When does Part B cover transplant medicines?
Part A generally must have been active at the transplant, and Part B when the eligible prescription is filled.
What is Extra Help for prescription drugs?
Extra Help can lower Medicare Part D drug costs for people with limited income and resources. Some people qualify automatically; others can apply through Social Security. It is separate from Part B coverage of eligible transplant medicines.
Learn about Extra Help on Medicare.gov · Apply through Social Security