Finding the top Medicare plan for dialysis treatments: a guide.
Medicare Advantage (MA) plans, which offer an alternative to Original Medicare, have become a more viable option for individuals with End-Stage Renal Disease (ESRD) requiring dialysis, thanks to recent legislative changes.
Traditionally, ESRD patients were restricted in their ability to enroll in Medicare Advantage plans. However, this has changed significantly with the 21st Century Cures Act, which came into effect on January 1, 2021. Now, ESRD patients can enroll in any Medicare Advantage plan, eliminating the need for special enrollment exceptions and restrictions.
One important exception to this rule are the Chronic Condition Special Needs Plans (C-SNPs), a subset of Medicare Advantage plans specifically designed for people with certain chronic conditions, including ESRD. These plans offer tailored benefits and care coordination, providing more specialized networks and services for those undergoing dialysis.
The timing of coverage for ESRD is unique. Unlike standard Medicare eligibility, which generally imposes a two-year waiting period for disability-based Medicare coverage, people with ESRD do not need to wait. Coverage starts during the fourth month of dialysis treatments, or even sooner if a patient participates in a Medicare-approved home dialysis training program. In such cases, coverage can begin in the first month of dialysis.
It's important to note that Medicare Advantage plans for ESRD patients do not duplicate benefits provided by Original Medicare. If a service is not covered by Medicare, it usually will not be covered by a Medicare Advantage plan either. There are also specific exclusions, such as the plan not paying the Medicare Part B deductible, nor covering services deemed not medically necessary by Medicare.
For the most current and personalized information, beneficiaries should consult with their plan provider or a Medicare counselor. It's essential to understand the specifics of each plan, including costs and coverage details, to make an informed decision about the best option for individual healthcare needs.
Sources: [1] Centers for Medicare & Medicaid Services (CMS). (2021). Medicare Advantage and the End-Stage Renal Disease (ESRD) Improvement Act of 1990. Retrieved from
- Health organizations and individuals across the nation are carefully observing the impacts of the 21st Century Cures Act, which allows End-Stage Renal Disease (ESRD) patients to enroll in any Medicare Advantage plan designated for health insurances, eliminating the need for special enrollment exceptions and restrictions.
- Due to recent legislative changes, chronic disease patients, such as those suffering from chronic kidney disease, can find specialized care in Chronic Condition Special Needs Plans (C-SNPs), a subset of Medicare Advantage plans tailored to people with particular medical conditions, including ESRD.
- Science and research continuously contribute to the development of medical solutions for chronic diseases, and an improved coordination of care offered by Medicare Advantage plans will significantly impact the overall health and wellness of people living with chronic kidney disease.
- It is essential for beneficiaries seeking more specific and personalized information about their health organizations or Medicare Advantage plans to consult with their plan providers, Medicare counselors, or medical professionals for the most up-to-date and accurate details regarding the costs, coverage, and exclusions of each plan.
