Medicare rules involving kidney failure

End stage renal disease (ESRD) qualifies a person for immediate Medicare enrollment.

If the person is still on an employer health plan when this occurs, there is a 30-month “coordination period” during which their private health insurance is the primary payer for covered dialysis expenses. Medicare is the secondary payer of expenses during this period, and may help pay covered expenses that the employer plan did not fully cover.

At the end of this 30-month coordination period, Medicare will become the primary payer for dialysis and transplant care. However, the private plan does not need to go away, and can fill the role of the secondary payer.

It’s also possible to get only Medicare Part A and B coverage and keep employer health insurance for drug coverage and other things. This coordination and the best way to proceed with both private insurance and Medicare can get complicated.

I suggest reading this official guide: Medicare Coverage of Kidney Dialysis & Kidney Transplant Services. For remaining questions, consider talking to a trained Medicare counselor with the State Health Insurance Assistance Program. The service is free.