Although eligible for Medicare, individuals with End-Stage Renal Disease (ESRD) have historically been restricted from enrolling in Medicare Advantage plans. The 21st Century Cures Act lifted that restriction beginning in 2021, which was a significant change for those with ESRD. The best time to learn more about Medicare Advantage options and Medicare Advantage plans is during the Medicare Annual Enrollment Period—also known as AEP—that runs every year from October 15-December 7.
ESRD and Medicare Advantage
Prior to January 1, 2021, individuals with ESRD, including those under age 65, had Medicare Eligibility to enroll in Original Medicare but were prohibited from enrolling in Medicare Advantage plans unless they:
Developed ESRD after enrollment or
Were grandfathered in through employer-sponsored coverage
As a result of a policy change that went into effect January 1, 2021, those with ESRD can now enroll in Medicare Advantage plans, which increases their options for chronic disease management and potentially more flexible or affordable payment opportunities.
End-Stage Renal Disease (ESRD) Medicare Coverage
Medicare benefits were extended to individuals suffering from End-Stage Renal Disease in 1972, and to this day, kidney failure is one of only two medical conditions that qualifies individuals for Medicare without a two-year waiting period regardless of age. There are specific rules and eligibility for coverage, but Original Medicare covers most services for ESRD treatment. Costs can vary depending on the type of treatment and services.
How to Prepare for End-Stage Renal Disease 2023 Medicare Advantage Enrollment with SelectQuote
Shopping around for Medicare coverage can seem intimidating, especially when there are new plans available, but we can help simplify the process and answer any questions you might have about Medicare Advantage eligibility, enrollment, or coverage for treatment of End-Stage Renal Disease (ESRD). The service is free, there’s no obligation to enroll, and we can help ensure you’re getting the Medicare benefits available to you.
