Medicare for kidney failure (ESRD): when coverage starts and how it coordinates
Eligibility for Medicare with end-stage renal disease, the dialysis and transplant start dates, the 30-month coordination period with employer plans, and Medigap options.
People of any age with end-stage renal disease (ESRD), permanent kidney failure needing dialysis or a transplant, can qualify for Medicare if they (or a spouse or parent) have enough work history.
When coverage starts
- In-center dialysis: the first day of the fourth month of dialysis.
- Home dialysis training: as early as the first month, if you start training within the first three months.
- Kidney transplant: the month you are admitted for the transplant, or up to two months earlier for pre-transplant care.
Coordination with employer coverage
If you have an employer group health plan, it pays first for a 30-month coordination period. After that, Medicare becomes primary.
After a transplant
Medicare coverage based only on ESRD ends 36 months after a successful transplant. Medicare Part B continues to cover immunosuppressive drugs for some people through a special Part B benefit, even after other coverage ends.
Medicare Advantage and Medigap
Since 2021, people with ESRD can join Medicare Advantage plans. Medigap access for under-65 ESRD patients depends on the state. The costs of Part B's 20% coinsurance on dialysis add up quickly; see how the 20% works.
Questions people ask
When does Medicare start for dialysis?
Usually the fourth month of in-center dialysis, earlier for home dialysis training.
Can someone with ESRD join Medicare Advantage?
Yes, since 2021.
How long does an employer plan pay first?
30 months.
Does Medicare end after a transplant?
ESRD-based Medicare ends 36 months after a successful transplant.
Independent educational site. Not affiliated with or endorsed by the U.S. government, the federal Medicare program, or any insurance company. Figures are 2026 amounts published by CMS unless noted; check Medicare.gov for your situation.