Medicare has been offering healthcare coverage for over 59 years to millions of Americans aged 65 and above, as well as people with certain disabilities such as kidney transplant. Let’s delve into the eligibility criteria for Medicare with kidney transplant.

How do I qualify for Medicare if I am 65 or older?

If you are 65 or older, you qualify for full Medicare benefits if:

  • Immigration Status: You must be a U.S. citizen or a permanent legal resident (green card holder) who has lived in the U.S. for at least five years. New immigrants are not eligible for Medicare regardless of their age.
  • You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits.
  • You or your spouse is a government employee or retiree who has paid Medicare payroll taxes while working but has not contributed to Social Security.

How do I qualify for Medicare if I am younger than 65?

The Medicare program is commonly for serving individuals who are 65 years or older. However, it’s important to note that younger adults with disabilities are also eligible for Medicare benefits.

If you are under the age of 65 and fall under any of the following categories, you may qualify for full Medicare benefits:

Social Security disability benefits: If you have been entitled to Social Security disability benefits for at least 24 months, you may qualify for Medicare. Most people who receive SSDI benefits become eligible for Medicare 24 months after they start receiving disability benefits.

Lou Gehrig’s disease: If you have ALS (amyotrophic lateral sclerosis), also known as Lou Gehrig’s disease, you may qualify for Medicare immediately. ALS is one of two conditions that bypass the 24-month waiting period. People with ALS automatically start Medicare the month their SSDI or Railroad Retirement Board disability benefits begin.

Permanent kidney failure:  If you have ESRD (end-stage renal disease) that requires regular dialysis or a kidney transplant, you may qualify for Medicare. People with ESRD are not required to sign up for SSDI to receive Medicare coverage, but they must take steps to enroll.

Disability pension from the Railroad Retirement Board: If you receive a disability pension from the Railroad Retirement Board and meet certain conditions, you may qualify for Medicare.

Medicare Advantage Coverage for Individuals Under 65 with ESRD

Before the 21st Century Cures Act of 2016, individuals with End-Stage Renal Disease (ESRD) under or above 65 were not eligible to enroll in Medicare Advantage plans. However, since January 1, 2021, this policy has changed, and those with kidney failure, including ESRD, can now choose between Original Medicare or a Medicare Advantage plan for their healthcare coverage, regardless of their age. This change provides more options for those with ESRD to choose the type of coverage that best meets their health needs. 

When does Medicare with kidney transplant take effect?

Dialysis Treatment:

  • New Enrollees Under 65: Medicare coverage typically starts on the first day of the fourth month of dialysis treatment for individuals using a dialysis center.
  • For those in a home dialysis program: coverage can commence from the first month of dialysis.
  • 65 or Older: Coverage for dialysis treatment can begin anytime after enrollment, without the waiting period experienced by younger enrollees.

Kidney Transplant:

  • New Enrollees Under 65: Medicare benefits usually start the month the individual is admitted to the hospital for a kidney transplant.
  • Coverage extends for 36 months after the transplant, when dialysis may no longer be required.
  • For  65 or Older: Similar to dialysis treatment, Medicare coverage for kidney transplants is available anytime after enrollment, without specific waiting periods.

When Do I Apply for Medicare?

Initial enrollment period

You can Apply for Medicare during your seven-month initial enrollment period, which starts three months before the month you turn 65 and ends three months after your birthday month.

Open Enrollment Period (October 15 – December 7)

Anyone with Medicare can join, switch, or drop a Medigap, Medicare Advantage, or drug plan. Your coverage will begin on January 1 as long as the plan gets your request by December 7.

Do You Need Medicare With Kidney Transplant? 

Skyline Benefit is an independent Medicare insurance broker that offers affordable and flexible Medicare options.

Selecting the best Medicare insurance plans and navigating open enrollment can be overwhelming; our mission is to simplify the process and help our clients every step of the way.

Schedule a consultation today. Call us at: (714) 888-5112

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