Medicare offers great coverage and benefits, giving you the ability to choose a plan that meets your specific needs, no matter what those needs are. While some people might think that older adults with certain disabilities or health concerns are unable to enroll in Medicare, that is not true – but there are some things you should know if you are living with certain conditions. For example, if you are living with Amyotrophic Lateral Sclerosis (ALS), or End Stage Renal Disease (ESRD), your Medicare Enrollment date might be different from most Medicare beneficiaries. So if you are diagnosed with one of these conditions, it is not only important to research and compare all of your plan options, but also to make sure that you enroll in Medicare at the right time.
If You Have ESRD
If you’ve been diagnosed with end-stage renal disease, and either have to have a kidney transplant or are undergoing dialysis, you will become eligible to enroll in Medicare on the first day of your fourth month of dialysis treatment. If you are taking part in a self dialysis treatment program, you will become Medicare-eligible immediately. But, if you decide to stop the self dialysis program and start going to a dialysis center, your benefits will stop and you will have to undergo 4 months of dialysis treatment before you can begin receiving Medicare benefits again.
Just like every other Medicare beneficiary, you will not have to pay a premium for Medicare Part A as long as you meet the requirements, but you will have to pay a monthly premium and meet an annual deductible for Medicare Part B coverage. Medicare Parts A and B will cover your:
- Dialysis
- Kidney transplant
- Transplant drugs after a covered transplant
- Dialysis-related drugs
Outpatient dialysis is covered under Part B, which is why it is important to enroll in Medicare as soon as possible so you can have this expensive treatment covered. Thankfully, due to legislation passed in 2019, Medicare coverage has been extended to include immunosuppressant drugs following a kidney transplant; many Medicare beneficiaries were unable to pay for these drugs out-of-pocket before this legislation was passed.
If You Have ALS
If you have been diagnosed with ALS, also known as Lou Gehrig’s disease, you will be automatically enrolled in Medicare the month that you begin receiving your Social Security disability insurance. You can receive Medicare Parts A and B coverage without a waiting period after diagnosis thanks to legislation passed in December 2020. Part B covers outpatient services, durable medical equipment, diagnostic tests, and other services to help treat ALS, like:
- Physical and occupational therapy
- Speech-language therapy
- Medicines used in intravenous infusions
Once enrolled in Parts A and B, you have the option to enroll in a Medicare Supplement Plan or a Medicare Advantage plan. A Medicare Supplement Plan will help you save money on Part B out-of-pocket costs.
Finding The Right Medicare Option
It should put your mind at ease to know that being diagnosed with ESRD or ALS will not prevent you from enrolling in Medicare or getting coverage for your treatment. You might have to wait for coverage, depending on your condition, but once you are eligible to enroll in Medicare, you will have options for more help. For example, you can enroll in a Part D plan for prescription coverage, and you can buy a Medicare Supplement Plan to help cover your Part B out-of-pocket costs, since Part B only covers 80% of your medical expenses.
If you are looking to enroll in Medicare, purchase a Medicare Supplement Plan, or just want to weigh your options before the Annual Enrollment Period (AEP) is over, EZ can help. Our agents work with the top-rated insurance companies in the country, and can compare all available plans in your area, at no cost to you. We will go over your medical and financial needs, and help you find a Medicare Supplement Plan that checks all of the boxes. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a local licensed agent, call 888-753-7207.
