Medicare is health insurance for people ages 65 or older, some disabled people, and people of all ages with end-stage renal disease (ESRD). Medicare is an “entitlement” program because people pay into it through taxes. Whether or not a person receives Medicare is not determined by his or her income, but by how much a person has worked (social security work credits). ESRD is the only chronic disease covered for people under the age of 65.
There are 4 parts to Medicare:
After the deductible, Medicare will pay 80% for most doctor services, outpatient therapy, preventive therapy, and durable medical equipment. You will have to pay the other 20% through your retirement/pension plan, private insurance, or out of pocket.
If you meet certain eligibility and income requirements, you may be eligible for Medicaid as well. People on both Medicaid and Medicare are called “dual eligibles”. You can check your eligibility for Medicaid by calling your local Department of Social Services office (In North Carolina, call the CARELINE at 1-800-662-7030).
Preventive services are an importnat part of staying healthy and preventing or delaying chronic diseases. Within the first six months of enrolling, Medicare will provide a "Welcome to Medicare" physical exam. When you enroll in Medicare, be sure to tell you doctor you wish to have this exam. This exam is only covered once, and is only covered during the first 6 months of enrollment.
There are other preventive screenings that are covered more often. Please click HERE for a printable checklist of preventive services covered by Medicare. Use this sheet to track the preventive benefits you use each year and remind you of benefits thatyou are eligible for.
Patients who have end-stage renal disease, which requires dialysis or kidney transplant, can be eligible for Medicare at any age if they meet certain requirements:
Patients can receive Medicare Part A benefits (Hospital Insurance) at any age if their kidneys no longer work, they need regular dialysis or have had a kidney transplant, and:
Just like with traditional Medicare, the patient has a premium and deductible (see Medicare section above) and they must pay 20% of the costs through a retirement/pension plan, private insurance, or out of pocket.
Medicare will only cover transplant patients for three years (36 months) after transplant.
Most ESRD patients will sign up for both Parts A and B of Medicare (if you are eligible for A, then you are eligible for B), as many services are not covered under just Part A. You must go to your local social security office to apply for the Medicare ESRD Program. You can find out where your local office is by calling this toll-free number: 1-800-772-1213, or click HERE.
The Centers for Medicare and Medicaid Services (CMS) has written a book all about Medicare coverage for kidney dialysis and kidney transplant services. Click HERE for a copy. This booklet is also available in Spanish.
Your child is eligible for Medicare based on End-Stage Renal Disease if:
In order to receive benefits, your child must be classified as a "dependent"—usually an unmarried person under age 22 who is your
Someone who is age 22 or
older is considered a dependent child if they have a disability that
began before they turned age 22. Someone between age 22 and age 26 is a
dependent child if they received at least one-half of their support from
you or your spouse from the time they turned age 22.
* For more information about eligibility for your grandchild or stepgrandchild, call the Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778.
Click HERE for a booklet on Medicare for Children with Kidney Disease
Source: Centers for Medicaid and Medicare Services