Great news for individuals who need ESRD coverage (end-stage renal disease)

Up until this point in time an individual who has been diagnosed with ESRD would have very limited options for coverage once on Medicare. Private plans were limiting what plans were available.

If someone was on dialysis when they turned 65 the person had the option of original Medicare, choosing a supplemental plan to go along with Medicare (because carriers cannot ask questions when someone turns 65) or a SNP (special needs plan) for individuals on Medicare. SNP plans for ESRD coverage are very few and far between.

It has not been an option for ESRD patients to choose a MAPD (Medicare Advantage plan). Private carriers all have asked the enrollee if they have ESRD and if so they would be disqualified from enrollment. If the individual already has a MAPD plan when they are diagnosed with ESRD they have three options. 

3 Options for ESRD Coverage

1. Stay on their current MAPD plan and hope that their doctors will continue to be in network and drugs continue to be covered.
2. Go back to original Medicare without the possibility of a supplemental plan to back it up
3. Find a special needs plan just for individuals in your area (very hard to find)

Beginning in 2021 things are changing! For the first time, people with ESRD will be eligible for standard MAPD plans. This is HUGE news. This means there are approx. 750,000 people who will now be able to take advantage of the protections and the extra benefits that are in these plans. Individuals who in the past have had really 2 options will have between 3 and 30 options.

In my experience, I have found the more options available the better fit you can find for your specific needs. 2021 should be a great time to look at new options for those looking for ESRD coverage.