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Insurance Options for People on Dialysis or With a Kidney Transplant

I have an Employer Group Health Plan (EGHP).
I have private insurance through the Affordable Care Act (Obamacare).
I have Medicare
I have Medicaid

I have an Employer Group Health Plan (EGHP).

  • If you are eligible for Medicare, your EGHP will be your primary insurance (pays first) for 30 months after starting dialysis or having a kidney transplant. This is called a coordination period. After 30 months, your EGHP will become your secondary insurance (pays second) and Medicare will become primary.
  • When should I apply for Medicare?

    You can apply for Medicare when you first start dialysis or wait and apply closer to the end of the 30-month coordination period. Once you apply you will be responsible for the monthly Part B premiums.

    If you are planning to have a transplant and want Medicare to help pay for your immunosuppressant medications you will need to apply for Medicare part A and B when you become eligible.
  • Insurance Choices for Dialysis and Transplant Patients with Private Insurance (Decision Aid)
First Steps to Transplant
A free self-paced online guide to transplant evaluation and getting on the waitlist.
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I have private insurance through the Affordable Care Act (Obamacare).

  • You do not need to apply for Medicare at any time unless you choose to. If you choose to apply for Medicare, and your private insurance plan is through the Affordable Care Act, you will lose your private plan coverage. This is because Affordable Care Act insurance plans are for people who no other insurance options. Once you have Medicare, you are considered to have other coverage and would no longer qualify for coverage through the Affordable Care Act.

I have Medicare.

  • Medicare covers 80% of costs for dialysis treatment and 80% of the cost of immunosuppressant medications needed after transplant.
  • Frequent Asked Questions about Medicare
  • Do I need a supplemental insurance to help cover what Medicare doesn't?
    • Ideally, yes. There are a few coverage options:
      • Medigap Plans – you must apply for these plans within 6 months after you first become eligible for Medicare. They are available to anyone over 65 years old. Some states also offer these plans for people under 65. To find out what Medigap plans are available in your state, contact your State Health Insurance Assistance Programs (SHIPs).
      • Medicaid – need to qualify based on income. Income requirements vary by state.
  • Thinking about Transplant?
  • Do I have other options for Medicare plans?
    • Yes:
      • Managed Care Plans – Some states are offering pilot programs enrolling people who are eligible for both Medicare and Medicaid.
      • Medicare Advantage – is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. 

I have Medicaid

  • Medicaid should cover most of your dialysis and transplant expenses.
    • If you are undocumented, you may have a limited form of Medicaid coverage, often transplant is not covered.

Resources if you are having trouble paying for your insurance premiums or medications.

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