If I start dialysis, how does that change my Medicare eligibility or coverage?

Question

Melonie Wood · Accepted Answer

Most people on dialysys are covered on their plan.  A member on Medicaid-Medicare, all cost would be covered, depending on their plan & cost share

Andrew Zurbuch, MBA · Answer

For both Original Medicare Part A & Part B for eligibility it doesn't. It does not change your eligibility status. If your entitled to Original Medicare, like working 40 quarters in the U.S., then you are entitled to it. It starts the Month of your 65th birth Month or the month after receiving 24 Months of Disability payments. This is just 2 of the ways to be eligible.  

As for coverage if your already on Medicare Part A & Part B at the time of your diagnosis then dialysis does not affect your status on Original Medicare. 

Claims regarding dialysis are a different question or questions & therefore not addressed herein. Thank you.

Andrew J. Zurbuch, MBA
Licensed Broker
Integrated Financial
azurbuch@i-f-s-in.com

Eli Roque · Answer

We have Medicare advantage plan that can help with the cost of dialysis depending in which county you live.

Bob Greco · Answer

If you go on dialysis or you are already on dialysis it does not affect your eligibility for Medicare. If you are already on Medicare and go on dialysis the way it is paid for may be affected but your coverage will stay constant.

Answered by Bob Greco on June 2, 2025

Agent Licensed in MO, IA & IL

Answered by Bob Greco Medicare Insurance Agent

Steven Bleicher · Answer

Once you have qualified for Medicare, it is permanent health insurance. Since we never know what the future holds for us, this is THE main reason for Medicare. Please don't forget that this system has placed a dollar value on over 60,000 treatments and procedures. Dialysis is indeed one of the 60,000 and you are entitled to receive this treatment!

Answered by Steven Bleicher on May 29, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Timothy Brown · Answer

Issuance of a Medicare card Part A& B begins after the 4 month of being on dialysis. Once the card is received, you’ll have the option of choosing a plan( Medicare Supplement or Medicare Advantage) to help offset or cover cost that Original Medicare does not.

Answered by Timothy Brown on May 22, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent

Yasmery Vargas · Answer

It does not change your eligibility or coverage.  Depending on the plan will ultimately decide out of pocket expense.

Bruce Kern · Answer

Definitely not as you are guarantee issue when you first turn 65. either with a Medicare Supplement or a Medicare Advantage Plan

Fred Manas · Answer

Starting dialysis changes Medicare eligibility and coverage in a few key ways. If you're not already eligible for Medicare, starting dialysis will likely trigger eligibility for Medicare Part A and Part B because of your End-Stage Renal Disease (ESRD). However, your Medicare coverage won't start immediately. There's a waiting period, and your commercial insurance (if you have it) will be primary for the first three months of dialysis. 
Here's a more detailed breakdown:
Eligibility:
If you haven't already met the typical Medicare age or disability requirements (65 or older, or under 65 with a qualifying disability), starting dialysis will make you eligible for Medicare due to ESRD. 
Waiting Period:
If you're under 65 and only eligible for Medicare because of ESRD, your Medicare coverage usually starts on the first day of the fourth month of dialysis. This means your commercial insurance (or any other coverage you have) will likely be the primary payer for the first three months. 
Medicare Parts:
You'll need both Medicare Part A (hospital insurance) and Part B (medical insurance) to get the full benefits for dialysis and kidney transplant services. You can also add Medicare drug coverage (Part D). 
Medicare Advantage:
While Original Medicare (Part A and B) covers many dialysis-related services, you can also enroll in a Medicare Advantage plan. These plans have different cost-sharing, provider networks, and coverage rules, so it's important to research them carefully. 
Coordination of Benefits:
For the first 30 months of your Medicare eligibility, your commercial insurance (if you have one) will be the primary payer for your dialysis treatments. After this period, Medicare will become the primary payer.

Vachik Chakhbazian · Answer

dialysis doesn't automatically change Medicare eligibility, but it triggers Medicare coverage for dialysis after a waiting period, typically the fourth month of treatment. If you're already eligible for Medicare, your coverage begins right away. If you're only eligible because of ESRD (End-Stage Renal Disease), the waiting period applies.

Answered by Vachik Chakhbazian on May 25, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Linda Davies · Answer

If you are already eligible for Medicare (65 or older, or disabled), dialysis coverage begins immediately. If you're under 65 and only eligible due to ESRD, Medicare coverage will usually start on the first day of the fourth month of dialysis treatments.

Answered by Linda Davies on June 8, 2025

Broker Licensed in IL

Answered by Linda Davies Medicare Insurance Agent

Eizel Mere · Answer

If you are under 65 you becomes eligible for Medicare. If you are over 65 and already have Medicare you continue with your coverage. It is a good idea to talk to an agent that can help you find a olan for your new situation.

Answered by Eizel Mere on May 19, 2025

Broker Licensed in FL

Answered by Eizel Mere Medicare Insurance Agent

Tony Hardwick · Answer

You would become eligible for a Chronic Special Needs plan. There are plans that are built specifically for individuals with diabetes, heart conditions, and ESRD.

Adam Ashby · Answer

There are a lot more details needed. ESRD is a qualifying event which allows individuals who have not obtained age 65 to qualify for Medicare. If you are already on Medicare, Dialysis may qualify you for C-SNP or Chronic Plans that may be available in your area. In either situation, it is best to connect with a Medicare Agent/Broker - someone who will be able to represent many carriers and find the best solution for you.

Answered by Adam Ashby on May 27, 2025

Broker Licensed in CO, NE, UT, WA & WY

Answered by Adam Ashby Medicare Insurance Agent

Jennifer Dixon · Answer

It does not affect your Medicare Coverage.  Most dialysis places have a case manager that will help you get extra benefits to cover the cost of dialysis.

Calvin Fritz · Answer

If you're under 65 and have end-stage renal disease (ESRD), which requires dialysis or a kidney transplant, you’ll become eligible for Medicare when you begin dialysis. This applies regardless of age, and you don’t need to wait until you're 65 to apply.

If you're over 65 and already on Medicare, there’s no change to your eligibility for Medicare; your coverage will continue as normal. However, starting dialysis might mean that you’ll need to adjust your plan choices to accommodate the new medical needs.

Joseph Lombardo · Answer

Thank you for your question. If you are under 65 and have ESRD (End Stage Renal Disease), eligibility for Medicare would start on the 4th month of dialysis, however, if you're 65 and over and already qualify for Medicare, your eligibility for coverage for dialysis would start immediately. I hope this helps.

Answered by Joseph Lombardo on April 21, 2025

Agent Licensed in NY, CT, NJ & PA

Answered by Joseph Lombardo Medicare Insurance Agent

Stephen Ashford · Answer

It doesn’tbchange your medicare eligibility. But it will qualify you for specific Medicare Advantage plans that are designed to meet the needs of people who need dialysis.

If I start dialysis, how does that change my Medicare eligibility or coverage?

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If I start dialysis, how does that change my Medicare eligibility or coverage?

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