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End-Stage Renal Disease (ESRD)

End-Stage Renal Disease (ESRD)

Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.

End-Stage Renal Disease (ESRD)

Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.

Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.

  • Curious to learn more about managing End-Stage Renal Disease? Download our comprehensive guide for valuable insights into treatment options, lifestyle adjustments, and support resources.
  • If a Medicare beneficiary has ESRD, Medicare has a special program, known as the ESRD Program, that provides coverage for dialysis and kidney transplant services for individuals with ESRD.
  • Under the ESRD Program, Medicare covers a variety of services
    related to ESRD, including inpatient and outpatient dialysis, kidney transplants, and certain medical supplies and equipment. The specific services that are covered and the costs that are associated with these services can vary depending on the type of service a beneficiary is receiving, and the specific Medicare plan they have.
  • It is important to note that Medicare coverage for ESRD services is generally limited to those that are medically necessary and that are provided by Medicare-approved providers. It is a good idea to review Medicare coverage and discuss treatment options with a healthcare provider to ensure that a beneficiary understands what
    is covered and what they may be responsible for paying.
  • ESRD significantly impacts quality of life and necessitates ongoing medical intervention. Understanding ESRD is crucial for patients, caregivers, and healthcare providers to ensure appropriate treatment and support.

    Curious to learn more about managing End-Stage Renal Disease? Download our comprehensive guide for valuable insights into treatment options, lifestyle adjustments, and support resources.

    Download our FREE eBook to learn more.

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    Essential Reads Inside Our Book

    Understanding How Medicare Works

    Book of Medicare is an accepted marketing publication by Medicare and Medicaid Services filed under MULTIPLAN_PACIFIC_BOM_M

    Medicare Part A

    Original Medicare Part A provides coverage for medically necessary:
    • Inpatient hospital care
    • Skilled nursing facility care
    • Home healthcare services
    • Acute care
    • Rehabilitation care
    • Skilled long-term care
    • Hospice care

    Book of Medicare is an accepted marketing publication by Medicare and Medicaid Services filed under MULTIPLAN_PACIFIC_BOM_M

    Medicare Part B

    Original Medicare Part B provides 80 percent coverage for a wide range of medically necessary services and supplies, including:
    • Primary care physician visits
    • Outpatient care
    • Preventive care services
    • Durable medical equipment
    • Mental healthcare
    • Laboratory tests
    • X-rays and other diagnostic tests

    Book of Medicare is an accepted marketing publication by Medicare and Medicaid Services filed under MULTIPLAN_PACIFIC_BOM_M

    Medicare Part C

    Medicare Part C, also known as Medicare Advantage Plans, are Medicare health plans offered by private insurance companies. These plans typically combine the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance) with prescription drug coverage, all in one plan, which is then an MAPD plan.

    Book of Medicare is an accepted marketing publication by Medicare and Medicaid Services filed under MULTIPLAN_PACIFIC_BOM_M

    Medicare Part D

    Medicare Part D helps cover the cost of prescription drugs; it is offered by private insurance companies and designed to work alongside Original Medicare. It is an optional program, which means the Medicare beneficiary does not have to enroll in a plan if they do not want prescription drug coverage. However, by not signing up for a Medicare Part D PDP when first eligible, a beneficiary will likely face a lifetime penalty if/when they decide to sign up later on.
    • Medicare Part D premiums are paid directly to the private insurance company. It has a deductible, copayments, and coinsurance for some drugs. The out-of-pocket costs to the beneficiary will depend on the Part D plan selected.
    • Medicare Part D does not cover all prescription drugs, and it does not cover drugs that are NOT medically necessary. It also does NOT cover drugs used for cosmetic purposes or for the treatment of weight loss or weight gain.
    • Plans change every year, so it is wise to seek out a local insurance agent to make sure the beneficiary is in a plan that is suitable for their needs.
    Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs.
    Read More

    Book of Medicare is an accepted marketing publication by Medicare and Medicaid Services filed under MULTIPLAN_PACIFIC_BOM_M

    Medicare Supplement

    Medicare Supplement Plans, also known as Medigap Plans, are a type of insurance which help cover the gaps not covered by Original Medicare. These costs include Part A and B deductibles, copayments, and coinsurance. Supplement plans are offered by private insurance companies and are designed to work alongside Original Medicare.
    • Medicare supplement plans are federally regulated standardized plans, which means they must follow certain rules set by the federal government. All Medicare Supplement plans must offer the same benefits regardless of which insurance company sells it.