Medicare provides excellent and comprehensive health insurance to millions including Americans with ESRD. In 2021, there are even positive changes in Medicare for those with ESRD.
Eligibility for Medicare & ESRD
If you have ESRD, you will be eligible for Medicare. You do not have to be 65. Because you will not be automatically enrolled you will need to contact your social security office to enroll. At that time you will enroll in Medicare Part A, your hospital insurance, and Medicare Part B, your outpatient insurance. There is usually no charge for Medicare Part A, but you may have to pay a monthly premium for Medicare Part B. This is determined by your income. You may qualify for special programs designed to help you pay for Medicare Part B. We’ll also touch on some of those momentarily.
What Does Medicare Cover?
Original Medicare covers your inpatient and outpatient care. Generally speaking Medicare will cover about 80% of the costs, leaving you with about 20%. Because of these out of pocket costs, the Medicare Part A deductible, and a need for prescription drug coverage, many people look for a Medicare Supplement Plan or a Medicare Advantage Plan. These plans cover the gaps of Original Medicare and help to limit your out of pocket spending. As of 2021, you cannot be denied a Medicare Advantage plan based on ESRD. So you can choose from either an Advantage Plan or a Supplement Plan to fulfill your specific needs. Medicare Advantage and Medicare Supplement Plans are actually drastically different, so please contact a licensed broker to find the plan that best suits your needs. You can find available plans on medicare.gov.
Prescription Drugs
Original Medicare does NOT cover most prescription drugs. Original Medicare will, however, cover transplant drugs and drugs needed for dialysis. However, should you have any other prescription drug needs, you will need either a Medicare Advantage Plan which includes prescription drug coverage or Medicare Part D. We strongly encourage you to enroll in some type of prescription drug coverage because without it, your prescriptions can be quite costly. Additionally, if you delay enrolling in prescription drug coverage, you may be subject to a late penalty. There are extra help programs available for Medicare Part D to help offset costs.
ESRD & DSNPs
Many who are eligible for Medicare due to ESRD are also eligible for Medicaid. Medicaid eligibility is determined by the federal poverty guide, household size and state. Many states have adopted expanded Medicaid programs with medically needy programs. If your medical needs are large enough you may be able to “spend down” your income therefore making you eligible for Medicaid. If you are eligible for Medicaid & Medicare, you may want to look into a dual special needs plan (aka DSNP). DSNPs are a type of Medicare Advantage Plan (Medicare Part C) which offer the full benefits of Medicare Part A, Medicare Part B, Medicaid and prescription drug coverage. They also offer several additional benefits. If you are eligible, we strongly encourage you to look into one of these plans for low cost options with extensive benefits.
What Else Should I Know?
In addition to DSNPs there are other Medicare Savings Programs based on your income and assets which can help pay for Medicare. If you do choose a DSNP (which is a type of Medicare Advantage plan) or a Medicare Supplement plan, please make sure to contact a broker. These plans are offered by private carriers and the benefits and prices can swing widely.
If you have any questions, please feel free to call us at iHealthBrokers at 888-918-0518 or schedule a call today. There is absolutely no charge for our services.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
