Termination of Medicare Coverage for Beneficiaries With
End-Stage Renal Disease (ESRD)
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Questions and Answers
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Q.
I
believe that because of my kidney condition, my Medicare benefits should not
end. What should I do?
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A.
You
have 30 days to contact your treatment facility. You should contact their representative toprovide evidence of your treatment status to the ESRD Network
responsible for the state where you live.
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Q.
Why
am I losing my Medicare benefits?
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A.
Under
the law, Medicare benefits for end-stage renal disease (ESRD) can only be
paid for 36 months after you receive a transplant or for 12 months after
dialysis stops.
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Q.
Why
has it taken so long for the Government to stop my benefits?
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A.
The
Social Security Administration (SSA) and the Centers for Medicare&Medicaid
Services (CMS) had various mechanisms in place to mark the records for
individuals whose Medicare benefits were scheduled to end. It was recently
brought to our attention that some of these mechanisms did not process the
terminations as expected. As a
result, many individuals did not have their Medicare benefits end on
time. The CMS has since corrected the
system. We regret any inconvenience this may have caused you.
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Q.
If
my Medicare benefits end, can I get my Medicare back?
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A.
You
can get Medicare coverage again if:
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- you go back on dialysis or
receive a kidney transplant, or
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- you are disabled and eligible
for Social Security disability payments.
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If any of
these events occur, you should contact your local Social Security office or
call Social Security at 1-800-772-1213 about applying for Medicare benefits.
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Q.
I
had a Medicare covered transplant and Medicare is now paying for my
immunosuppressive (transplant) drugs.
If my Medicare benefits stop, how will my drug coverage be affected?
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A.
As
of the date your Medicare benefits end, Medicare can no longer pay for your
transplant drugs. If you are worried
about paying for your transplant drugs, you should talk to your doctor, nurse
or social worker. There may be other
ways to help you pay for these drugs.
State Health Insurance Assistance Program offices are also available
to assist you. To access this list,
you can go to our Web site at www.medicare.gov
and click on Helpful Contacts. Or,
you can call 1-800-MEDICARE and ask the operator for assistance.
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Q.
Will
I need to pay for items or services Medicare paid for (e.g.,
immunosuppressivedrugs) that
should have been billed to my other insurance company or me?
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A.
No.
Medicare will not request payment from you for those services that were
provided to you during the period prior to the receipt of the formal
termination notice from SSA.
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Q. If my Medicare coverage ends, where
can I go for medical assistance?
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A.
Please
check with your local State Health Insurance Assistance Program. You can also contact your States Medical
Assistance office. Telephone numbers for each State can be found in the
telephone book or on the Medicare.gov web site under Helpful Contacts.
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Q.
I
received a bill for Medicare Part B premiums. Should I pay it?
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A. Yes, you should pay the amount due.
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Q.
Ive
paid Medicare premiums for the past several years. Will I be reimbursed the amount Ive paid in premiums?
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A.
No. You will not be reimbursed for the
premiums you paid during the time you were covered by Medicare.
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