End stage renal disease is stage 5 of chronic kidney disease where the kidneys are functioning at a maximum of 15 percent of their normal capacity. When this happens the kidneys cannot effectively remove waste or excess fluid from the blood. When this diagnosis is present, people are eligible for the end stage renal disease medical care program and Social Security disability benefits. Below is an explanation from Social Security about these benefits.
Medicare
Eligible individuals who are undergoing a course of dialysis or a kidney transplant may contact Social Security to enroll in Medicare. Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). If you get Medicare Part A (hospital insurance), you can also enroll in Medicare Part B (medical insurance). You will need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services.
In deciding whether to enroll in Medicare, there are certain factors to consider such as:
- Do you currently have medical coverage through a group health plan? and
- What are the disadvantages to postponing Medicare enrollment?
When an ESRD patient has existing GHP coverage, Medicare is the secondary payer of Medicare-covered services for a period of time known as the 30-month coordination period. The 30-month coordination period starts the first month you are eligible to get Medicare because of kidney failure (usually the fourth month of dialysis), even if you have not signed up for Medicare yet. At the end of the 30-month coordination period, Medicare will pay first for all Medicare-covered services. Check with your plan’s benefits administrator to see how your employer plan works with Medicare.
Social Security Disability Benefits
If you are not working at levels that are above the substantial gainful activity (SGA) level, you may be eligible to receive disability cash benefits. Individuals automatically get Medicare Part A and Part B after 24 months of disability benefit entitlement. To file an application for monthly disability benefits, you may file online or contact your local Social Security office.
