End-Stage Renal Disease Medicare - How You Can Qualify

By: Edward Neeman
Published: Wednesday, November 14 2018
Last Updated: 4 years ago

Medicare for patients with end-stage renal disease provides coverage for a host of medical services aimed at treating permanent kidney failure. It includes regular dialysis or a kidney transplant. This coverage is offered alongside the traditional medical services that Medicare covers.

What Is End-Stage Renal Disease (ESRD)?

End-stage renal disease is a condition where your kidneys can no longer function effectively to meet the needs of your body. The condition commonly occurs when you have a chronic kidney disease that leads to a gradual loss of function to below 10% of their normal ability.

Other health problems may also cause the loss of function. At an advanced stage, the kidney may never get well enough to work as they should. The damage may occur for several years worsening as the years go by to a point where the kidneys stop to function altogether.

You have two options for treatment; regular dialysis to clean the waste from your blood or a kidney transplant. However, some people prefer taking conservative care of their bodies by managing symptoms for the best quality of life for the remainder of their years.

What Symptoms do You Watch Out For

The symptoms of end-stage renal disease grow worse with time, and may not appear until the kidneys are damaged beyond treatment. Human kidneys are highly adaptable and can compensate for the loss of function until they fail altogether. In a later stage of chronic kidney disease, you may experience the following symptoms:

  • Itching at different parts of the body.
  • Vomiting and nausea
  • Not feeling the urge to eat even after long periods without food.
  • Problems sleeping
  • Too much or too little urine
  • Swollen ankles and feet
  • Decreased mental sharpness

If the kidneys finally stop working, you may notice several of the symptoms below:

  • Diarrhea
  • Rashes
  • Vomiting
  • Belly or abdominal pain
  • Fever
  • Recurrent nosebleeds
  • Shortness of breath when fluids accumulate in the lungs.
  • Muscle cramps and twitching

If you experience any of the above symptoms after having experienced any of those listed under chronic kidney disease, seek immediate medical attention. It’s always best to catch illness or disease in its early stages.

What Causes End-Stage Renal Disease?

Some of the most common diseases that cause ESRD include:

  • Type1 and Type II diabetes
  • High blood pressure
  • Autoimmune diseases such as IgA nephropathy or lupus.

Kidney conditions that may cause ESRD to include:

  • Genetic ailments like polycystic kidney disease.
  • Glomerulonephritis, an inflammation of the filtering units.
  • Interstitial nephritis which is the inflammation of the tubules and other structures.
  • Prolonged obstruction of the urinary tract from conditions such as cancer, kidney stones, and enlarged prostate.
  • Recurrent kidney infection or pyelonephritis.

Can You Get Medicare With ESRD?

You can get Medicare with ESRD. Medicare gives a chance for patients to enroll in the program and start enjoying the benefits without the standard two-year waiting period imposed in many other chronic conditions. Your age is not a factor when applying for Medicare coverage with end-stage renal disease, so you will become eligible before your 65th birthday.

Why Does Medicare Cover End-Stage Renal Disease?

End-stage renal disease is a chronic condition where the life of a patient depends on medical procedures such as dialysis or kidney transplant for them to survive. Unfortunately, both of these options are very expensive especially for dialysis which has to be done regularly. Medicare steps in to give support to these patients on a lifeline and ensure that they do not die for lack of funds to cater for these medical services.

Medicare ESRD Eligibility Requirements

You are eligible for ESRD Medicare at any age if all of the points below apply to you.

  • Your kidneys do not function anymore.
  • You require regular dialysis or a kidney transplant. One of these apply to you
  • You have worked for enough time with Railroad Retirement Board, Social Security or were a government e employee.
  • Already getting or are eligible for Railroad Retirement benefits or Social Security.
  • You are a dependent child or a spouse of a person that has fulfilled any of terms above.

Is ESRD Medicare The Primary for the Condition?

Medicare is usually a second player to group health plans for a coordination period of 30 months after which it becomes primary for the patient. When you enroll in Medicare based on your kidney failure, the coverage becomes primary when:

  • On the fourth month of dialysis if you have it in a dialysis facility.
  • In the first month if you take part in a home dialysis training program conducted by a Medicare-approved provider to do self-dialysis effectively or when you start self-dialysis program before the third month of dialysis.
  • Once you are admitted to a Medicare-approved hospital for a kidney transplant or pre-surgical treatment.

When Does The Coverage End?

If you met Medicare ESRD eligibility requirements and took the coverage due to the end-stage renal disease alone, the coverage will come to an end after meeting the conditions below:

  • 12 months after you stop dialysis treatments.
  • 36 months after having a kidney transplant.

You can re-enroll for coverage if you need to undergo another kidney transplant or dialysis after the expiry of the period. Medicare for end-stage renal disease gives patients a new lease of life by providing lifesaving coverage. It is flexible and has few limitations. If you have met the cover’s ESRD eligibility requirements, taking the cover is the best way to handle the costs associated with treating the condition.