End Stage Renal Disease (ESRD) is kidney failure requiring dialysis or a transplant. In general, the Centers for Medicare & Medicaid Services (CMS) requires that individuals with ESRD continue to use Medicare Parts A and B, traditional Medicare, instead of joining a Medicare Advantage plan. However, there are certain exceptions:
- If you were already in a Medicare Advantage (MA) plan when you were diagnosed with ESRD, you do not have to go back to original Medicare, and your plan cannot tell you to leave because of your diagnosis. Also, if you would prefer to join another plan offered by the same company you’re with now, you can do so.
- If you have healthcare coverage with an employer or union through a Medicare Advantage plan carrier, you may be able to switch from your employer’s or union’s coverage to a plan offered by that MA carrier.
- If you have had a successful kidney transplant, you may be able to join a Medicare Advantage plan of your choice.
- If you have been diagnosed with ESRD, but are already in a Medicare Advantage plan and that plan decides to discontinue coverage or leave your service area, you have a one-time right to join another Medicare Advantage plan. You don’t have to join another Medicare Advantage plan immediately, however, if you decide to go to traditional Medicare, then decide that you would prefer to be in a Medicare Advantage plan instead, you can still join a Medicare Advantage plan later as long as that plan is enrolling new members.
- If a Medicare Special Needs Plan (SNP) for people with ESRD is accepting new members in your area, you can join that plan to get Medicare Advantage coverage.