Receiving a diagnosis for a chronic condition like kidney disease can be overwhelming, and you may not know where to find the support you need. During March, which is National Kidney Month, we want to bring attention to a few of the ways Medicare coverage can support your care during various stages of kidney disease.

Kidney disease education

Kidney disease education is fundamental to staying as healthy as possible and avoiding complications from kidney disease. Original Medicare (Parts A and B) covers up to six sessions of kidney disease education services if you have stage IV chronic kidney disease. Kidney disease education teaches you how to best care for your kidneys and gives you information you need to make informed decisions about treatment. 

This education will explain:

• Treatment options
• What you should and shouldn’t eat
• How kidney disease medications work
• How you may feel
• How kidney disease can affect your family and social life

In addition to the benefits covered by Original Medicare, Medicare Advantage plans focus on whole-person wellness and may provide extra resources. Learn more about the resources available through an ApexHealth Medicare Advantage plan by visiting our website or by calling our ApexAssistants at (844) 279-0508 (TTY: 711).

End-Stage Renal Disease (ESRD) 

If you are diagnosed with End-Stage Renal Disease (ESRD), Original Medicare or a Medicare Advantage plan can help you get the care you need. ESRD occurs when you have permanent kidney failure and require a regular course of dialysis or a kidney transplant. If you have ESRD at any age, you’re eligible for Medicare if your kidneys no longer work, you need regular dialysis or have had a kidney transplant.

If you are eligible for Medicare because of age, you can also choose a Medicare Advantage plan. While this wasn’t always the case, people with ESRD are able to enroll in Medicare Advantage plans to get their coverage as of 2021. Medicare Advantage plans cover the same education and transplant services as Original Medicare, and many plans include prescription drug coverage that Original Medicare doesn’t cover.

Before enrolling with a Medicare Advantage plan, be aware that some have a limited network of doctors and specialists. If you are choosing a Medicare Advantage plan, check to make sure that your kidney doctors are included in the Medicare Advantage plan’s network. ApexHealth is proud to work closely with an integrated network of providers and hospitals, anchored by Atrium Health and Atrium Health Wake Forest Baptist, to ensure our members get unmatched expertise and personalized care. 

Kidney transplant services

Medicare will cover your kidney transplant only if it’s done in a hospital that’s Medicare-certified for kidney transplants. Medicare Part A will cover transplant services like kidney registration fees, lab tests and cost of care for your kidney donor. Part B covers services like doctors and transplant drugs. 

Most kidney transplants are performed on people who are on dialysis. If you have Original Medicare, you’ll pay 20% of the Medicare-approved amount for all covered dialysis-related services. Medicare will pay the remaining 80%. 

If you need a kidney transplant, Medicare will pay the full cost of care for your kidney donor. You’ll pay nothing for Medicare-approved laboratory tests or any blood needed under most circumstances.

Medicare Advantage plans like those provided by ApexHealth can also cover you if you need to pay for doctor’s visits, hospital stays and outpatient visits after transplants. If you experience an unexpected medical crisis or need to stay in the hospital for an extended period of time after your kidney transplant, a maximum out-of-pocket limit (MOOP) can help protect you from paying too much. Once your covered medical expenses meet your MOOP, the plan will pay 100 percent of your covered Part A and Part B medical costs for the rest of the plan year. Make sure that you check with the plan that you’re interested in to confirm the limit they set.  

No matter where you are in your journey, we hope these answers can help you find the right care for kidney disease. To learn more or get resources in North and South Carolina, call our ApexAssistants at (844) 279-0508 (TTY: 711). Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.

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