The Medicare Advantage and ESRD

When diagnosed with something like End State Renal Disease (ESRD), there may be a lot of information to take in. Understanding Medicare benefits is just one of the steps. Medicare Advantage is an option under the Medicare program.

Medicare Advantage

• Medicare Advantage (MA) plans are contracted by Medicare to provide benefits to Medicare beneficiaries. They must provide at least the same benefits as original Medicare, but most plans offer more. They usually do so at a higher price and with different rules and restrictions.

Kidney Disease

• ESRD is permanent kidney failure that must be treated either with dialysis or a kidney transplant. ESRD patients are Medicare-eligible four months after beginning dialysis, as soon as they have a transplants or once they begin a self-dialysis program.

Enrolled with Medicare Advantage

• If a beneficiary is diagnosed when he is a current beneficiary of a MA plan, the MA plan must continue coverage. If the MA plan folds or leaves the area, the beneficiary has the right to join another MA plan.

New to Medicare Advantage

• If the beneficiary joins Medicare due to ESRD, he does not have the right to join an MA plan. He may only join original Medicare or a Special Needs Plan.

Special Needs Plans

• There are MA plans that are specifically designed to serve those with ESRD. These are the only MA plans that most ESRD for which beneficiaries are eligible to sign up.