Medicare Insurance for ESRD

The Medicare insurance is the special type of insurance which has been designed for people who are 65 or older and disable people of any age. The main purpose of this insurance is to provide them the different type of insurances related to health within one package. Usually, there are different healthcare related insurance plans for the different situation but Medicare insurance in America covered most of them in this single insurance plan. So, whether you are looking for the hospital expenses, medical services, and drug coverage, the Medicare insurance will provide coverage on all of them.

The end-stage renal disease people have been usually ignored when we talk about the Medicare insurance. Even if you go to the market and explore different insurance companies who are providing help regarding the Medicare insurance on the basis of commission earning, do not really talked about people who are suffering from the end-stage renal disease. This is the main reason behind the less popularity of Medicare Insurance for the ESRD.

The federal government of United States of America has included the end-stage renal disease people at the very early launch of the Medicare insurance in 1965. But still, it does not make the equal opportunity in the insurance industry due to lack of knowledge and information.

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The end stage renal diseases have many kinds. One example of them is permanent kidney failure. For treatment, the patient needs to bear expenses of transplant, ESRO, and dialysis etc. The Medicare insurance plan covers all of these expenses on the behalf of the patient only if they have purchased the right plan for them.

ESRD Medicare Insurance Eligibility

A person can become eligible for the ESRD Medical Insurance as soon as after the first dialysis treatment. There is not much requirement to claim the coverage but yes, it could be a bit time taking the process or you need to wait up to 3 months for the coverage after the regular dialysis begins.

The Medicare Insurance has been usually famous for the old people but for the ESRD patient, there isn’t any age requirement. As long as the doctor advice for the regular dialysis or kidney transplant, the person becomes eligible for the ESRD Medicare insurance.

When Medicare Coverage End for the ESRD patients?

Like any other health-related insurance, the coverage end when the patient has been recovered completely. Examples of dialysis and transplant patients are:

  • The coverage ends 12 months after the last dialysis treatment for the dialysis patient
  • The coverage ends 36 months after the kidney has been transplanted.

There are multiple insurance plans and even the coverage ratios have been sold by the insurance companies. So, the coverage could have the different ending period in special cases but this is the standard time which most of the ESRD patient got after they claim the insurance coverage.

Once a patient has taken benefit from the Medicare insurance, the 3-month eligibility criteria will be removed from him and the patient can enroll for the Medicare Insurance instantly.

Getting drug coverage with Medicare

As a Medicare user you probably know that Original Medicare Part A and Part B do not cover drug prescriptions and that you will have to pay for the medication your doctor prescribes you. If you would like to save some money, there are two ways in which you can get drug coverage with Medicare through some plans that Medicare offers. In this article you will find information about these and how to enroll on them.

     How to can I drug coverage with Medicare?

There are two ways in which you can get drug coverage with Medicare. The first one is through a Medicare Prescription Drug Plan (Part D), which adds drug coverage Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans. You can get one of these through a private insurance company.

The second way in which you can get drug coverage with Medicare is through a Medicare Advantage Plan, like a Health Maintenance Organization plan.  With a Medicare Advantage Plan you get Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance) and prescription drug coverage. These types of plans are also known as “MA-PDs” because they include the drug coverage. This plans are also gotten through a private insurance company.

     What do these plans cover?

Depending on the plan you get, the coverage will vary. However, each plan has a formulary, which is a list of covered drugs and they are placed in “tiers”, so each tier has a different cost. Medicare drug plans can make changes in their formularies, but they must inform you through a written notice at least 60 days before the changes become effective if you are taking a drug that is involved in them. Additionally, Medicare drug plans must cover all commercially available vaccines.

When and how can I enroll on a Plan with drug coverage?

You can enroll on one of these plans or make changes on the plan you already have on specific times.

The first moment in which you can get one is during the Initial Enrollment Periods for Part C & Part D, when you first get Medicare. In this case, there a few situations that influence the moment when you can get the plan.

If you are new eligibly because you just turned 65, you have a disability and you are under 65 or you have both a disability and just turned 65, you can enroll on a plan with drug coverage 3 months before you turn 65, during the month you turn 65 or 3 months after you turn 65. In case you are under 65, the month in which the person turns 65 will be replaced with your 25th month of getting disability benefits.

If you have Medicare Part A coverage and you enrolled in Mutual of Omaha Medicare Supplement during the Part B General Enrollment Period (January 1–March 31), you can sign up for a Medicare Advantage Plan between April 1 and June 30. If you do not have Medicare Part A coverage and you enrolled in Medicare Part B as previously mentioned, you can sing up for a Medicare Prescription Drug Plan between April 1 and June 30.

The second moment in which you can get a plan with drug coverage is during the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage. The third moment in which you can get a plan with drug coverage is during the Medicare Advantage Disenrollment Period. If you do it during the MA disenrollment period, you will have to switch to Original Medicare and join a Medicare Prescription Drug Plan.