10128, Medicare Coverage of Kidney Dialysis and Kidney ...

Medicare Coverage of Kidney Dialysis & Kidney Transplant Services

This official government booklet tells you:

? The basics of Medicare ? How Medicare helps pay for

kidney dialysis and kidney transplants ? Where to get help

CENTERS FOR MEDICARE & MEDICAID SERVICES

The information in this booklet describes the Medicare Program at the time this booklet was printed. Changes may occur after printing. Visit , or call 1-800-MEDICARE (1-800-633-4227), to get the most current information. TTY users can call 1-877-486-2048. "Medicare Coverage of Kidney Dialysis & Kidney Transplant Services" isn't a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.

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Table of contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Section 1: Medicare basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Section 2: Kidney dialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Section 3: Kidney transplants . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Section 4: Medicare drug coverage (Part D) . . . . . . . . . . . . . . . . . . 29 Section 5: Costs & payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Section 6: Filing a complaint (grievance) about dialysis or

kidney transplant care . . . . . . . . . . . . . . . . . . . . . . . . . 39 Section 7: Other kinds of health coverage . . . . . . . . . . . . . . . . . . . 41 Section 8: Where to get more information . . . . . . . . . . . . . . . . . . . 45 Section 9: Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

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Introduction

This booklet explains what Medicare covers and how Medicare helps pay for kidney dialysis and kidney transplant services in Original Medicare.

People with End-Stage Renal Disease can choose either Original Medicare or a Medicare Advantage Plan when deciding how to get Medicare coverage. Turn to page 7 for more information.

If you're in a Medicare Advantage Plan (or another Medicare health plan), your plan must give you at least the same coverage that Original Medicare gives. But, your costs, rights, protections, and/or choices of where you get your care may

be different. You may also be able to get some extra benefits. Read your plan materials or call your benefits administrator for more information.

Talk with your health care team to learn more about permanent kidney failure and your treatment options.

Your doctors, nurses, social workers, dieticians, and dialysis technicians make up your health care team. Your health care team can help you decide what's best for you based on your situation. If you have questions about Medicare or need more information, visit , or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

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SECTION

1

Medicare basics

What's Medicare?

Medicare is health insurance for: ? People 65 and older ? People under 65 with certain disabilities ? People of any age with End-Stage Renal Disease (ESRD) (permanent

kidney failure requiring dialysis or a kidney transplant)

Words in blue are defined on pages 49?51.

What does Medicare cover?

Medicare Part A (Hospital Insurance) helps cover: ? Inpatient care in hospitals ? Skilled nursing facility care ? Hospice care ? Home health care

Medicare Part B (Medical Insurance) helps cover: ? Services from doctors and other health care providers ? Outpatient care ? Home health care ? Durable medical equipment (like wheelchairs, walkers, hospital beds, and

other equipment) ? Many preventive services (like screenings, shots or vaccines, and yearly

"Wellness" visits)

For more details about what Medicare covers, visit , or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

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