Can I get Medicare Supplement Coverage if I Have End-Stage Renal Disease (ESRD)?
This article was updated on: 09/16/2018
Medicare is a government health insurance program. Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance). To be eligible for Medicare, you must be a U.S. Citizen or permanent resident for at least five continuous years. Medicare is available for people over 65, but people under 65 with certain health conditions and disabilities may also qualify for Medicare. One condition that can qualify you for Medicare coverage at an age younger than 65 is End-Stage Renal Disease (ESRD) which is permanent kidney failure requiring dialysis or a transplant, according to Medicare.gov.
If you’re on kidney dialysis or are a kidney transplant patient, you might not be automatically enrolled in Medicare, but you may be able to enroll in Medicare Part A and Part B by contacting Social Security.
What is Medicare Supplement (Medigap)?
Unlike many employer-sponsored health-care plans, Original Medicare has no out-of-pocket maximums. This means that even with Medicare coverage, you could be responsible for thousands of dollars, or more, in out-pocket-expenses after you receive treatment. This is where Medicare Supplement (also known as Medigap) comes in. Medicare Supplement plans are administered by private insurance companies and might pay for some of Original Medicare’s out-of-pocket costs, such as copayments, coinsurance, and deductibles. In most states, there are 10 standardized Medicare Supplement plans, although not all plans may be available in all areas. The most basic Medicare Supplement plan is Plan A (not to be confused with Medicare Part A). Plan A may cover:
- Medicare Part A coinsurance and hospital costs up to an additional 365 days after your Original Medicare benefits are used up
- Medicare Part B coinsurance or copayment
- Blood (first 3 pints)
- Part A hospice care coinsurance or copayment
Click here to view a table that compares the 10 standardized Medicare Supplement plans available in most states. Massachusetts, Minnesota, and Wisconsin have their own standardized plans.
Who can sign up for Medicare Supplement?
The laws about who can sign up for Medicare Supplement vary from state to state. However, federal law doesn’t require insurance companies to sell Medicare Supplement policies to anyone under age 65. That means that (for example) if you’re a 42-year-old with ESRD and Original Medicare coverage, you might not be able to purchase a Medicare Supplement policy to go alongside your Original Medicare, depending on which state you live in. For example, California and Vermont don’t make Medicare Supplement plans available to people under 65 with ESRD. (If you are 65 or older with ESRD you may be able to purchase a Medicare Supplement policy in these states.)
The good news is many states do require Medicare Supplement insurance companies to sell Medicare Supplement plans to people under 65, including people under 65 with ESRD. So if you live in the following states, you may be able to purchase Medicare Supplement insurance to go alongside your Original Medicare coverage:
· New Hampshire
· New Jersey
· New York
· North Carolina
· South Dakota
If you’re in a state that doesn’t require Medicare Supplement policies be sold to you (if you’re under 65 and have ESRD), it’s possible that some insurance companies may voluntarily sell you a Medicare Supplement policy. However, you might pay a higher premium.
Are there other options for me if I can’t enroll in Medicare Supplement?
If you are an unable to enroll in a Medicare Supplement policy or unable to afford a plan that is available to you, you may be able to apply for other help with your health-care costs. One option available to you may be Medicaid. Your eligibility for Medicaid may depend on your modified adjusted gross income, as well as other factors. Another option may be a Medicare Special Needs Plan or SNP. Special needs plans are limited to people with specific diseases or situations. A Medicare SNP may provide access to specialists in certain diseases that affect its members.
If you still have questions about Medicare plans available to people with end-stage renal disease, I am happy to help you find answers. If you prefer, you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about plan options in your area by clicking the Compare Plans button.
The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the Federal Medicare program.