A to Z Health Guide

FAQ About Medicare for Kidney Patients

I applied for Medicare, when will my Medicare coverage begin?
The effective date of Medicare based on ESRD is dependent upon the type of treatment you choose:

  • For hemodialysis patients Medicare is effective the 4th month of treatment
    For example, if hemodialysis is begunin May, Medicare becomes effective August 1.
  • For home dialysis patients Medicare is effective the first month of treatment.
  • For transplant recipients Medicare is effective
    • the month you're admitted to the hospital for a kidney transplant or for health care needed prior to a transplant if the transplant takes place that same month or within the following two months.

    OR

    • Two months prior to transplant if the transplant is delayed more than two months after you are admitted to the hospital in anticipation of transplantor related health services

How do I know if I have worked enough to qualify for Mediare?
You earn 1 work credit for earning a specific amount of money($1,300 in 2017) from work in a 3-month quarter. The chart below gives a general guide to number of work credits needed to qualify for Medicare at a particular age. To find out how many work credits you have, call Social Security at 1-800-772-1213.

Your Age Now

Number of Work Credits Needed to Qualify for Medicare

Under 24

6 credits in the last 3 years before kidney failure

24-30

Worked at least half the time from age 21 until kidney failure

For example, if you are 30, you must have at least 18 credits (9 yers of work x2 quarters each year = 18.

31-43

20 credits in the 10 years before kidney failure

44-61

20 credits in the last 10 years, plus 2 credits for every 2 years age 44 and older.

For example, if you are 58, you must have at least 36 credits (10 years of work x 2 quarters each year = 20, plus 8 two-year periods since age 44 x 2 credits each year = 16

62 & older

40 credits

I have insurance through my employer - do I need to apply for Medicare too?
If you have health insurance through your employer, you will be subjected to the Medicare Coordination of Benefits (COB) period. This means that your employee group health plan will pay for your dialysis treatment for 30 months and then Medicare will automatically become your primary insurance. If you choose to continue to keep your employee group health plan it would then become secondary to Medicare and could help pay the extra 20% not covered by Medicare part B.

I have insurance through the Affordable Care Act Marketplace, should I apply for Medicare too?
If you have insurance through the ACA's marketplace, you do not need to sign up for Medicare unless you want to. You should evaluate your costs and coverage with the ACA plan vs Medicare. To help here is a Kidney Care Insurance Worksheet which is designed to help compare plans offered in the health insurance marketplaces established by the Affordable Care Act, so you can choose the most affordable and comprehensive plan. It is also important to note that if you apply for Medicare you will lose any subsidies you receive from your ACA Marketplace coverage. If you chose not to enroll in Medicare when your kidneys fail, you will have penalties with higher premiums if you chose to enroll later.

Remember Medicare only pays 80% of dialysis treatment so you will need a supplemental plan (Medigap) so you should also calculate this cost into your assessment. For people under 65 years old there may not be a supplement plan available in your state. To find out what supplemental policies are available in your state contact your State Health Insurance Assistance Programs (SHIPs).

I have Medicare only. Can I sign up for supplemental insurance through the Affordable Care Act Marketplace?
No, the Affordable Care Act Marketplace only provides primary insurance to people without any health insurance coverage. You may want to see if you are eligible for Medicaid in your state or contact your State Health Insurance Assistance Programs (SHIPs) to see if there are supplemental insurance policies available for you in your state. If you would like personal help understanding Medicare A, B, D, and Medigap supplement plans, plus how to enroll in a suitable plan, contact your state's SHIP. These trained volunteers are experts in Medicare resources, and provide unbiased insurance counseling.

Date Reviewed: 
February 14, 2017

The information shared on our websites is information developed solely from internal experts on the subject matter, including medical advisory boards, who have developed guidelines for our patient content. This material does not constitute medical advice. It is intended for informational purposes only. No one associated with the National Kidney Foundation will answer medical questions via e-mail. Please consult a physician for specific treatment recommendations.