End-Stage Renal Disease
Return to Information for Older Adults
End-Stage Renal Disease (ESRD) is when you have permanent kidney failure that requires a regular course of dialysis or a kidney transplant.
If You Have ESRD and Medi-Cal, DHCS Recommends That You Apply for Medicare
You can sign up for Part A and Part B by contacting your local Social Security office or by calling Social Security at (800) 772-1213. TTY users can call (800) 325-0778.
Please refer to the Medicare eligibility for Medi-Cal members with ESRD factsheet.
ESRD Medicare Eligibility
If you are an individual of any age and have ESRD you may be entitled to Medicare Part A and can get Medicare Part B for full benefits, if all the following applies:
- Your kidneys no longer work.
- You need regular dialysis or have had a kidney transplant.
- One of the following applies to you:
- You have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee.
- You are already receiving or eligible for Social Security or Railroad Retirement benefits.
- You are the spouse or dependent child of a person who meets the requirements listed above.
How do I get Medicare?
If you're eligible for Medicare because of ESRD and you qualify for Part A, you can also get Part B. Signing up for Medicare is recommended if you have ESRD and are enrolled in Medi-Cal. But, you will need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services. You can sign up for Part A and Part B by contacting your local Social Security office or by calling Social Security at (800) 772-1213.
When does my Medicare Coverage begin if I have ESRD?
| Your Coverage Begins | Under the Following Circumstances |
First month
| Medicare coverage can begin as early as the first month of a regular course of dialysis treatments if you meet all of these conditions:
- You participate in a home dialysis training program offered by a Medicare-certified training facility during the first 3 months of your regular course of dialysis.
- Your doctor expects you to finish training and be able to do your own dialysis treatments at home.
- You maintain a regular course of dialysis throughout the waiting period that would otherwise apply.
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First day of the month
| If you receive a kidney transplant from a Medicare-certified hospital.
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| Same month | If you are admitted to a Medicare-certified hospital for a kidney transplant (or for health care services that you need before the transplant) if your transplant takes place in the same month or within the next two months.
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| Two months before the month of your kidney transplant | If your transplant is delayed more than two months after you are admitted to the hospital for the transplant or for health care services you need before the transplant.
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| First day of the 4th month | If you receive a regular course of dialysis at an inpatient or outpatient dialysis facility, you are eligible for Medicare starting the first day of the fourth month you receive dialysis. For example, if you began receiving dialysis on June 5, your Medicare coverage starts September 1.
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When does my Medicare coverage end?
If you have Medicare only because of permanent kidney failure, Medicare coverage will end:
Your Medicare coverage will resume if:
- You start dialysis again, or you get a kidney transplant within 12 months after the month you stopped getting dialysis.
- You start dialysis or get another kidney transplant within 36 months after the month you get a kidney transplant.
