Kidney disease has its own Medicare rules. End-stage renal disease (ESRD) is one of the ways to get Medicare before 65, and the timing of dialysis, transplant and employer coverage affects costs for years. For Oregonians with chronic kidney disease (CKD) heading toward dialysis or transplant, here's how it works.
Getting Medicare because of ESRD
You can get Medicare at any age if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and you (or your spouse or parent) have worked enough under Social Security or the Railroad Retirement Board, or you get those benefits. Sign up through Social Security (1-800-772-1213).
| Situation | Medicare usually starts |
|---|---|
| In-center dialysis | The first day of the fourth month of dialysis (dialysis starting July 1 means coverage starting October 1) |
| Home dialysis training | The first month of dialysis, if you start a Medicare-certified home training program in the first three months and keep up treatment |
| Kidney transplant | The month you're admitted to a Medicare-certified hospital for the transplant, or up to two months earlier if the transplant is delayed |
If you apply late, coverage can reach back up to 12 months. ESRD-based Medicare ends 12 months after dialysis stops, or 36 months after a successful transplant, unless you're also eligible because of age or disability. See disability and Medicare in Oregon.
The 30-month coordination period
If you have an employer or union group health plan when you become eligible because of ESRD, that plan pays first and Medicare pays second for 30 months. After that, Medicare pays first. Tell your providers about both coverages so they bill correctly. Each new ESRD-based Medicare entitlement starts a new 30-month period. See employer coverage and Medicare in Oregon.
Dialysis
- In-center dialysis at a Medicare-certified facility: Part B.
- Home dialysis (peritoneal or home hemodialysis), including training, equipment and supplies: Part B.
- Drugs used with dialysis, such as those for anemia and bone health, are generally part of the dialysis payment under Part B.
- Dialysis as a hospital inpatient: Part A.
You generally pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026; CMS announces 2027 amounts in the fall). A Medigap policy can pay that coinsurance; in Oregon, people under 65 with Medicare get a Medigap open enrollment period too (OAR 836-052-0138). Use Medicare's Care Compare to find dialysis facilities near you.
Kidney transplant
Medicare covers kidney transplants at Medicare-approved transplant centers. Part A covers the transplant hospital stay, the costs of finding a donor kidney and the living donor's care; Part B covers doctors' services. OHSU in Portland has a kidney transplant program, and some Oregonians also use centers in Washington, Idaho or California. Medicare's Care Compare and the transplant center can confirm Medicare approval.
Anti-rejection drugs after a transplant (Part B-ID)
- While you have Medicare, Part B covers immunosuppressive (anti-rejection) drugs if Medicare paid for your transplant.
- ESRD-based Medicare ends 36 months after a successful transplant. Since 2023, the Part B immunosuppressive drug benefit (Part B-ID) can keep paying for these drugs, and only these drugs, if you had ESRD Medicare at the time of the transplant and don't have other coverage that includes them.
- Part B-ID has its own monthly premium and the Part B deductible; after the deductible you pay 20%. Enroll any time by calling Social Security at 1-877-465-0355 or mailing form CMS-10798. A Medicare Savings Program may help with costs.
Before ESRD: chronic kidney disease
- Kidney disease education: Part B covers up to 6 sessions if you have stage IV chronic kidney disease and a doctor's referral, to help you prepare for dialysis, transplant or other choices. You pay 20% after the deductible.
- Medical nutrition therapy: covered for people with kidney disease (or diabetes) with a referral; you pay nothing if the provider accepts assignment.
- Kidney specialist visits: Part B, with 20% coinsurance.
- Drugs: Part D plans cover drugs such as Jardiance and Farxiga when prescribed for kidney disease, according to each plan's formulary. Covered Part D costs are capped at $2,400 in 2027.
Choosing coverage with ESRD
- Original Medicare works with any Medicare-certified dialysis facility and transplant center in the U.S., which helps if you travel or move.
- Medicare Advantage: since 2021, people with ESRD can join any Medicare Advantage plan in their area. Confirm that your dialysis facility, kidney doctor and transplant center are in the network before you enroll. Some special needs plans are for people with chronic conditions such as ESRD, where offered. Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
- OHP and Medicare together: if you also qualify for the Oregon Health Plan, OHP can help with Medicare premiums, deductibles and coinsurance. See dual eligibility in Oregon.
- Public employees: OEBB lets an early retiree keep OEBB medical coverage after becoming Medicare-eligible because of ESRD (OAR 111-050-0015). See OEBB and Medicare.
Timing matters: talk through your options before you start dialysis if you can. You can request a call from a licensed insurance agent, or meet licensed insurance agents in Oregon.
Related guides
Medicare by condition
All condition guides.
Disability and Medicare in Oregon
Medicare before 65.
Dual eligibility (Medicare and OHP)
Coordinating benefits.
Sources
- Medicare.gov — End-stage renal disease (ESRD)
- Medicare.gov — Dialysis services and supplies
- Medicare.gov — Kidney transplants
- Medicare.gov — Kidney disease education
- Medicare.gov — Medical nutrition therapy services
- Medicare.gov — Care Compare (dialysis facilities)
- OAR 836-052-0138 — Medigap open enrollment, including under 65 (via Cornell LII)
- OAR 111-050-0015 — OEBB early retiree coverage and Medicare (via Cornell LII)
Frequently asked questions
Does Medicare cover dialysis?
Yes. Part B covers outpatient dialysis in a Medicare-certified facility and home dialysis, including training, equipment, supplies and the drugs used with dialysis. Part A covers dialysis as a hospital inpatient. You generally pay 20% of the Medicare-approved amount after the Part B deductible.
When does Medicare start with ESRD?
Usually on the first day of the fourth month of dialysis. It can start in the first month if you begin a Medicare-certified home dialysis training program in the first three months, or in the month you're admitted for a kidney transplant (or up to two months earlier if the transplant is delayed). Coverage can be retroactive up to 12 months if you apply late.
What is the 30-month coordination period?
If you have employer or union group health coverage when you get Medicare because of ESRD, that plan pays first and Medicare pays second for 30 months. After that, Medicare pays first. Each new ESRD-based Medicare entitlement starts a new 30-month period.
Does Medicare keep paying for anti-rejection drugs after a transplant?
ESRD-based Medicare ends 36 months after a successful transplant, but the Part B immunosuppressive drug benefit (Part B-ID) can keep paying for anti-rejection drugs if you had ESRD Medicare at the time of the transplant and don't have other coverage for them. It has its own monthly premium; call Social Security at 1-877-465-0355 to enroll.
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