Permanent kidney failure [End-Stage Renal Disease (ESRD)] is a medical condition in which a person's kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life. Beneficiaries may become entitled to Medicare based on ESRD. Benefits on the basis of ESRD are for all covered services not only those related to the kidney failure condition.

Medicare is secondary to group health plans (GHPs) for individuals entitled to Medicare based on ESRD for a coordination period of 30 months regardless of the employee and employer status. The provisions for ESRD are applied without regard to the number of individuals employed and the employer coverage does not have to be based on current employment only. Medicare is secondary to GHP coverage from COBRA or a retirement plan. Medicare is secondary during the coordination period even if the employer policy or plan contains a provision stating that its benefits are secondary to Medicare.

When Medicare Coverage Ends

1. If the beneficiary has Medicare only because of ESRD, Medicare coverage will end:
* 12 months after the month the beneficiary stops dialysis treatments, or
* 36 months after the month the beneficiary had a successful kidney transplant.

Note: There is a separate 30-month coordination period each time a beneficiary enrolls in Medicare based on ESRD. For example, if the beneficiary receives a kidney transplant that continues to work for 36 months, the beneficiary's Medicare coverage will end. If after 36 months, the beneficiary enrolls in Medicare again based on ESRD, there will be a new 30-month coordination period.