a. Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney transplant unless they are eligible for Medicare on another basis such as age or disability. Edward may, however, remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would cover the drugs.
When an individual becomes eligible for Medicare due to end-stage renal disease (ESRD), their Medicare coverage typically continues for 36 months after the month of the kidney transplant. After this 36-month period, their Medicare coverage based on ESRD may end unless they qualify for Medicare based on other factors, such as age (65 and older) or disability.
In Edward’s case, since he is now 12 months post-kidney transplant, his Medicare coverage based on ESRD would continue for another 24 months. However, once the 36-month period is over, he may lose Medicare coverage based on ESRD, unless he qualifies for Medicare based on age (turning 65) or disability. During this time, he may continue to be enrolled in Part B, but solely for coverage of immunosuppressive drugs, if he has no other healthcare coverage that would cover these drugs.
It’s important for Edward to plan ahead and explore other potential sources of healthcare coverage once his Medicare coverage based on ESRD ends after the 36-month period, to ensure he has continued access to necessary medical services and medications.