When your kidneys stop working, every day turns into a race for treatment — dialysis, transplant evaluations, pills, and lab draws. If you’ve hit this point, the last thing you need is confusion about how to pay for care.

ESRD, or end-stage renal disease, means your kidneys have stopped working, and you need regular dialysis or a kidney transplant. If you’re facing this diagnosis, you’re not just managing symptoms — you’re building a new routine around life-saving care.

Medicare has special eligibility criteria for people with end-stage renal disease. If you have kidney failure — no matter your age — Medicare could open the door to paying for critical treatment.

This coverage answers an urgent need, but it also raises questions. Who qualifies? When does Medicare start? If you have private insurance, what happens next? What will it all cost?

Let’s start with eligibility.

Who qualifies for Medicare with ESRD?

While Medicare was created to cover healthcare costs for seniors in retirement, if your kidneys have failed and you need regular dialysis or a kidney transplant, you may qualify for Medicare before you turn 65. In fact, if you have ESRD, you could be eligible for Medicare even if you’re in your twenties or teens.

But there’s a second requirement: work history. You, your spouse, or a parent must have paid Medicare payroll taxes for the required period. This usually means about 10 years of work or coverage through a parent or spouse if you’re younger.

You’re also eligible if you (or your family member) qualify for Social Security or Railroad Retirement Board (RRB) benefits, even if you’re not yet receiving them. Ask your dialysis clinic or transplant coordinator for guidance if you’re unsure about your eligibility. These people work with the complex end-stage renal disease Medicare rules daily and can help you confirm your qualifications.

When Medicare coverage for ESRD begins and how it works with employer, individual, or family insurance

It’s important to note that once you enroll in Medicare for ESRD, coverage does not start right away. Medicare ESRD coverage usually starts on the first day of the fourth month after your regular dialysis treatments begin. For instance, if you start dialysis in January, your Medicare coverage typically starts May 1. That means Medicare doesn’t cover your first three months unless you qualify in another way.

There are key exceptions: If you train for at-home dialysis under your provider’s supervision, Medicare may start as soon as your first month. Getting a kidney transplant or being admitted for transplant-related services can also move up your start date, sometimes covering you retroactively to the month you began transplant preparation.

Until Medicare starts, keep any employer or union coverage you have. This bridges the gap during those initial months. 

Once Medicare begins, your employer insurance continues to play a crucial role. During the first 30 months after you become eligible for Medicare kidney failure benefits, your employer or union plan pays first, and Medicare pays second. This “coordination period” helps cover more of your medical costs. After 30 months, Medicare becomes your primary payer.

What Medicare covers for ESRD

Medicare’s ESRD coverage is broad. It covers most dialysis services, whether you receive treatment in a hospital, at a dialysis center, or at home. Here’s a brief breakdown:

• Medicare Part A covers hospital stays, transplant surgery, and the costs of finding and transporting a donated kidney.
• Medicare Part B covers doctor visits, outpatient dialysis, home dialysis training and supplies, and immunosuppressant drugs after a transplant (if you were eligible when you received your transplant in a Medicare-approved facility).
• Drug coverage for other prescriptions may fall under a Part D plan. Confirm your current or future plan covers immunosuppressants if your Medicare ESRD coverage ends.

If you have a Medicare Advantage plan (Part C), you get all the same dialysis Medicare benefits as Original Medicare and may have access to additional benefits like vision, dental, and hearing coverage. Some plans may help with transportation to dialysis and other support programs. Check the plan details or visit Medicare.gov for specifics.

Costs to expect with Medicare ESRD coverage

Even with Medicare’s broad coverage, you’ll have some out-of-pocket costs. Every ESRD patient with Medicare pays a monthly premium and an annual deductible for Part B. For 2025, the annual deductible for Part B beneficiaries is $257. The standard monthly premium is $185, but it may be higher depending on your income.

After you meet your deductible, you’ll typically pay 20% of the Medicare-approved amount for most doctor services. Dialysis supplies and home treatments also fall under this 20% coinsurance.

You may want to enroll in a Part D prescription drug plan if you need coverage for medicines not included under Part B. This is especially important if you’ve received a kidney transplant, since you’ll typically need prescription drugs, like immunosuppressants, for life. A Part D plan will cover these medications, and 2025 brings additional cost-saving programs for people who rely on Part D.

Financial help may be available through Medicaid or Medicare Savings Programs for those with lower incomes. Your social worker or financial coordinator can help you apply.

How long does Medicare coverage last for ESRD?

Medicare for ESRD lasts as long as you need ongoing treatment, through dialysis or transplant care. If you stop requiring dialysis and haven’t had a transplant, coverage ends 12 months after your last dialysis treatment. If you received a kidney transplant, Medicare coverage usually continues for 36 months after the month of your transplant.

There are exceptions. If you qualify for Medicare another way after this period — by age (65+) or disability — you can keep your Medicare coverage. If your kidneys fail again and you need more dialysis or another transplant, you can reapply for Medicare at any age.

If you receive a kidney transplant, you’ll need to take immunosuppressant drugs long term to prevent your body from rejecting your new kidney. Medicare Part B covers these medications while you have Medicare for ESRD, but coverage may end after 36 months.

Some people may qualify for continued drug coverage under a special Medicare program, depending on when their transplant happened and whether they have other insurance.

Your next steps to managing and treating ESRD

End-stage renal disease changes your routines, plans, and sometimes even how you imagine the future. Thankfully, Medicare can support you through these changes.

Every time you clarify a benefit or reach out for help, you’re taking charge of your health. Connect with your care team, lean on loved ones, and keep asking questions. If you want help sorting through your options, including Medicare Advantage plans for people with ESRD, reach out to SmartMatch today. Our team is here to make sure you get the coverage and support you deserve.