Last updated September 13, 2024
When to use:
People with Medicare and ESRD have questions about their ESRD coverage under Medicare.
NOTE: If the caller has ESRD but their question is not related to coverage or eligibility specific to ESRD, then help the caller as usual, including reaching out to the Tier 3 staff via the Tier 3 Support chat with questions.
Examples of when to refer:
Examples of when to refer:
- Beneficiary has questions on how their immunosuppressive medications will be covered.
- Beneficiary has questions on if they should take ESRD Medicare Part B and keep employer coverage.
- Beneficiary has questions on dialysis coverage while traveling.
Examples of when not to refer, and to help the person directly:
- Beneficiary has ESRD and is new to Medicare and needs a Medicare plan comparison/counseling (there are no "special plans" for people on ESRD).
- Beneficiary has ESRD and Medicare and is having trouble with Medical Assistance eligibility/renewal.
- Beneficiary has ESRD and is having trouble with Part D medications at the pharmacy.
- Beneficiary with kidney failure was denied Social Security Disability status.
- Beneficiary has Medicare due to disability (not ESRD) or age and wants Medicare Advantage perk (e.g., gym membership) to be covered and now has failing kidneys.
Steps staff should take:
- Confirm the caller is asking about their specific coverage or eligibility as it relates to their ESRD. If so, continue to step 2.
- Collect caller's name, date of birth, phone number, and answers to these questions in the CTS case.
- What coverage does the person currently have?
- Are they working? Will they continue to work?
- Is the caller on or going on dialysis or have they had a kidney transplant?
- When does the ESRD Medicare begin or when did it begin?
- Does the caller have questions about coverage or eligibility specific to ESRD?
- Warm transfer the call to Tier 3 support queue.
Sample language:
"Thank you for the great question. Let me get you connected with one of my coworkers that specializes in coverage and eligibility questions as it relates to End-Stage Renal Disease."
- Transfer ownership of the case to the Tier 3 staff who took the call so they can take it over.
- Note: Tier 3 staff will take over the case but may end up sending it back to you for a plan comparison, applying for extra help, or other non-ESRD specific related needs.
What is ESRD?
End-Stage Renal Disease (ESRD) is an advanced stage of chronic kidney disease (stage 5). People of any age with ESRD can qualify for Medicare if they meet the other eligibility requirements.
Visit Medicare.gov for up-to-date information on Medicare and End-Stage Renal Disease.