Does Medicare Cover ESRD (End-Stage Renal Disease)?

Medicare Benefits Solutions
Mar 9, 2021

The body does a lot of work to filter out toxins and reduce chemical compounds through organs like the liver and kidneys. In particular, the kidneys function as a filter for your blood and produce waste in the form of urine. When damaged or suffering from dysfunction, toxins and waste can build up in the blood and lead to damage elsewhere in the body.

Some kidney diseases can be treated with medication or lifestyle and diet changes, but others may require ongoing dialysis or a kidney transplant. The latter treatment options are often the case when kidney disease, also referred to as a renal disease, has reached its end stage. Essentially, this means that the disease has progressed to a point where the damage is irreversible and symptoms are difficult to treat effectively.

Does Medicare Cover End-Stage Renal Disease (ESRD)?

Medicare is often thought of as a medical insurance option only available to seniors, but in some cases, there is no age requirement in order to participate in Medicare. The program is designed to offer care options to individuals of all ages when certain disabling medical conditions arise, and ESRD is one of these conditions.

If you have ESRD, regardless of age, you qualify for Medicare as long as you also qualify for Social Security payments and you have kidneys that no longer work and you require regular dialysis or have had a kidney transplant. In terms of coverage benefits, Medicare provides coverage for a range of clinical services and prescription medications as well as hospital care and surgery.

To address routine doctor visits and lab work, Medicare provides benefits under Part B, the outpatient benefit. Medicare Part B also covers expenses related to dialysis and transplant surgery if required. If you require admittance to a hospital or skilled nursing facility, Medicare offers coverage through benefits outlined under Medicare Part A, the inpatient benefit. Prescription medications are covered by Medicare Part D as long as the drugs are purchased from a retail pharmacy. If medications are administered during a clinical visit, Medicare Part B would apply, and if given while admitted to a care facility, Medicare Part A would apply.

Medicare and Rehabilitation After Surgery

If you do end up needing a kidney transplant as part of your treatment for ESRD, Medicare also provides coverage for rehabilitation in most cases. This can include coverage of follow-up visits, lab work and physical therapy, and some Medicare Advantage plans may also cover nutrition counseling that is specifically designed to address the concerns of individuals who are post-transplant.

Immunosuppressive drugs may also be covered under Medicare Part D through Original Medicare as well as Medicare Advantage plans. In order to ensure the process moves along as efficiently as possible, it would be a good idea to involve your Medicare plan provider in your care plan alongside your doctor and specialists.