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Termination of Medicare Coverage for Beneficiaries With End-Stage Renal Disease (ESRD)

Termination of Medicare Coverage for Beneficiaries With

End-Stage Renal Disease (ESRD)


Questions and Answers


Q.                 I believe that because of my kidney condition, my Medicare benefits should not end. What should I do?


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.


Q.                 Why am I losing my Medicare benefits?


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.


Q.                 Why has it taken so long for the Government to stop my benefits?


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.


Q.                 If my Medicare benefits end, can I get my Medicare back?


A.                  You can get Medicare coverage again if:

  • you go back on dialysis or receive a kidney transplant, or
  • you become age 65, or
  • you are disabled and eligible for Social Security disability payments.

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.


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?


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 and click on “Helpful Contacts”. Or, you can call 1-800-MEDICARE and ask the operator for assistance.


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?


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.


Q. If my Medicare coverage ends, where can I go for medical assistance?


A.                  Please check with your local State Health Insurance Assistance Program. You can also contact your State’s Medical Assistance office. Telephone numbers for each State can be found in the telephone book or on the web site under Helpful Contacts.


Q.                 I received a bill for Medicare Part B premiums. Should I pay it?


A. Yes, you should pay the amount due.


Q.                 I’ve paid Medicare premiums for the past several years. Will I be reimbursed the amount I’ve paid in premiums?


A.                  No. You will not be reimbursed for the premiums you paid during the time you were covered by Medicare.



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