End-Stage Renal Disease (ESRD) and advantage plans Medicare coverage

End-Stage Renal Disease (ESRD) and advantage plans 2019 Medicare coverage

Medicare is a government health insurance program. Original Medicare consists of Part A and Part B. To qualify for Medicare, you must be a US citizen or permanent resident for at least five years. Medicare is available to people 65 and older, but people under 65 with certain health conditions and disabilities may qualify for Medicare. A condition that qualifies you for Medicare under the age of 65 is end-stage renal disease (ESRD), which is a persistent kidney failure that requires dialysis or a transplant.

If you have kidney dialysis or are a kidney transplant patient, you may not have automatically registered with Medicare. However, you can enroll in Medicare Part A and Part B by contacting Social Security.

What is Medicare supplement plan(Medigap)?

Original Medicare, unlike most employer-sponsored health policies, has no limits on self-financing. This implies that you will be responsible for many thousands of dollars or even more for expenses, despite Medicare coverage after treatment has been done. This is where the Medicare supplement comes in.

Medicare supplemental plans are managed by private insurance companies and can pay some of the original costs of Original Medicare, such as co-pays, co-insurance and deductibles. There are 10 standardized Medicare supplement plans in most states, although not all plans may be available in all areas. The most basic Medicare supplemental plan is Plan A (should not be confused with Medicare Part A). Medicare Plan A may include:

  • Hospital costs and Medicare Part A coinsurance for up to 365 days after your original Medicare benefits have run out
  • Medicare Part B coinsurance or co-payment
  • Blood (the first 3 pints)
  • Part A Hospice care co-insurance or additional payment

There are tables which compare the 10 standardized Medicare supplement plans from most states. Minnesota, Massachusetts, and Wisconsin have their own standardized plans.

Who can sign up for a Medicare supplement?

The laws of who can enroll for a Medicare supplement vary from state to state. However, federal law does not require insurance companies to sell Medicare supplemental policies to seniors below 65 years of age. This means that if a senior is 42 years old and have ESRD and Original Medicare, he may not be able to purchase a Medicare supplemental plan to complement original Medicare depending on the state in which he resides.

For instance, California and Vermont do not offer Medicare supplement plans for people below 65 with ESRD. If you are 65 years or older and you have been diagnosed with ESRD, you may be eligible to purchase a Medicare supplement policy in those states.

The good news is that many states require Medicare supplemental insurance companies to sell Medicare supplemental plans to people under 65, including people under 65 with ESRD.  If you are in a state where you are not required to have Medicare Supplement policies offered to you (i.e. you are below 65 and have an ESRD), some insurance companies may voluntarily offer you a Medicare Supplement plan. However, you may pay a higher premium.