END STAGE RENAL DISEASE AND MEDICARE

If your doctor has diagnosed you with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant, sometimes called ESRD), you may be eligible for Medicare coverage.

How to Sign Up for Medicare

If you need Medicare because of ESRD, you can enroll in Medicare Part A and Part B by visiting your local Social Security office or by calling Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

To avoid paying a higher Part B premium, you should enroll in Medicare Part B when you apply for Medicare Part A. The cost of Part B will go up 10% for each 12-month period that you could have had Part B but didn’t sign up for it.

When Medicare Coverage Begins

When you enroll in Medicare for ESRD and you are on dialysis, your Medicare coverage usually starts the first day of the fourth month of dialysis treatments. For example, if you start getting your dialysis treatments in July, your Medicare coverage would start on October 1st.

GETTING HELP TO PAY FOR HEALTH CARE COSTS NOT COVERED BY MEDICARE

You may qualify for help to pay your expenses that Medicare does not cover (for example, monthly premium, deductible and co-insurance). Two programs that may help pay for these expenses are Medicaid and Medicare Savings Programs.

Medicaid is a joint Federal and State program that helps pay medical costs for some people with limited income and resources. Most health care costs are covered if you qualify for both Medicare and Medicaid.

Medicare Savings Programs pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare with a low income and limited assets. To qualify for these programs, you must have the following:

  • Medicare Part A (Hospital Insurance).
  • A monthly income below a certain amount for an individual, or for a married couple.
  • Assets of a limited amount for an individual, or for a married couple.
    • Not all assets are counted.
    • The most common assets that are counted include money in a checking or savings account, stocks, certificates of deposit (CD’s), and bonds.

To see if you qualify for these programs, call your local Department of Human Services (DHS) office. It is very important to call if you think you qualify – even if you are not sure.

When you apply, you may have to provide proof of the following:

  • Your income
  • Your assets
  • Your identity and citizenship
  • Recent medical records (within last 6 months), documentation of disability (if applicable)

Make sure you indicate you are interested in both Medicaid and the Medicare Savings Program when you apply.

IF YOU QUALIFY FOR MEDICAID

You will receive a letter from you local DHS office telling you what benefits you qualify for. If you qualify to have Medicaid pay all or part of your Medicare premiums, co-insurance or deductibles, you will receive a mihealth card in the mail. You will need both your Medicare card and the Medicaid mihealth card to access services. Use the mihealth card for co-insurance charges and deductibles. It usually takes about four months from the date you are approved before Medicaid begins paying your Medicare premiums. You may get a refund for premiums you paid during that time.

FOR MORE INFORMATION

For more information about Medicare for people with End-Stage Renal Disease, you can visit www.medicare.gov on the web. You can view or download a copy of the “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services” handbook. You can also download a copy of “Medicare and You”, a general handbook on Medicare.

The information provided here was obtained from the Medicare website, “Medicare and You” handbook, and “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services” handbook. This information is meant to be a general overview and may not contain the most recent updates; for more detailed and up-to date information you should visit the Medicare website at www.medicare.gov or call 1-800-325-0778. For questions relating to Medicaid, please call 1-800-642-3195 or visit the Michigan Medicaid website at www.michigan.gov/dhs.

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