ESRD Medicare for people also eligible due to age or disability

Medicare and End-Stage Renal Disease (ESRD)

You can have Medicare for those with End-Stage Renal Disease (ESRD Medicare) at the same time you have Medicare based on disability or age. Whether or not you need to enroll in ESRD Medicare at the same time you are enrolled in Medicare based on age or disability depends on which you had first.

If you have ESRD Medicare before becoming eligible for Medicare due to age or disability, you should enroll in Medicare again in addition to your ESRD Medicare. This is because ESRD Medicare can end under certain circumstances, and enrolling in age or disability Medicare ensures that you have coverage to meet your health care needs.

If you have age or disability Medicare before developing ESRD, you do not have to enroll in ESRD Medicare. However, there are circumstances when you may want to enroll in ESRD Medicare:

  • You need an earlier Medicare start date. ESRD Medicare can be retroactive up to one year.
  • You want to eliminate your Part B late enrollment penalty (LEP). If you declined Part B during your Initial Enrollment Period (IEP), you may have an LEP. Enrolling in ESRD Medicare waives your Part B LEP.
  • You want to shorten the 24-month waiting period for Medicare due to disability. In general, you must collect Social Security Disability Insurance (SSDI) for 24 months before you are eligible for Medicare. If you become eligible for ESRD Medicare, you can have Medicare before your disability waiting period ends.

Coordination of benefits

If you had ESRD Medicare first before becoming eligible for age or disability Medicare, any group health plan (GHP) coverage you have – meaning job-based, retiree, or COBRA coverage – pays first during the 30-month coordination period. After the 30-month coordination period, Medicare pays first.

If you enroll in ESRD Medicare after already having Medicare due to age or disability, you will still have a 30-month coordination period. However, Medicare and your GHP coverage are primary or secondary following standard coordination of benefits rules. After your 30-month coordination period ends, Medicare is primary.