Medicare for Those with ALS or ESRD

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Your Medicare eligibility is usually based on age, as most US citizens and permanent residents over the age of 65 can receive these health care benefits. For those with end-stage renal disease (ESRD) or Catastrophic Lateral Sclerosis (ALS), there are some exceptions to the age rule. 

While people under 65 with other disabilities will generally have a long waiting period for Medicare, those with ESRD or ALS can access the healthcare advantages much sooner. Original Medicare is also referred to as Part A and Part B. Part A covers hospital expenses, while Part B is for outpatient services.

ESRD Medicare Eligibility Requirements

If you have ESRD and have started dialysis, coverage can start after three months. This waiting period is shortened to just one month if it is at home dialysis. You can continue to receive Medicare benefits up to 12 months after dialysis has ended.
For anyone who needs a kidney transplant, Medicare can start from the time they are first admitted to the hospital. You will continue to be eligible for up to 36 months after the kidney transplant. There may be limited choices for people with ESRD when applying for Medicare Advantage Plans.

ALS Medicare Eligibility Requirements

Someone who has been diagnosed with ALS will be eligible for Original Medicare as soon as they start receiving Social Security disability benefits. 
These cash payments usually start five months after a person has been assessed as having a disability. People with ALS can boost their Medicare Part A and Part B with a Medicare Advantage Plan, or Part D. 

Medicare Part D

Medicare Part D is an optional extra but most people with ALS or ESRD will benefit from this. Part D gives you a reduction in the cost of prescription drugs and this can potentially save you a significant amount of money.
Anyone who is eligible for Medicare Part A and Part B will be entitled to a prescription drug plan. It is important to check with your provider to learn which drugs they cover as not every package will be the same.

Applying for Medicare

The first step for those with ALS or ESRD is to apply for Social Security Disability Insurance (SSDI) with Social Security. When filling out these forms ensure you clearly specify the type of disability you have.
Remember, it is best to do this as early as possible as there will be a five month waiting period before payments begin. Your Medicare will start at the same time as your SSDI, but there may be some exemptions for people with ESRD who are undergoing dialysis or have had a kidney transplant.
Original Medicare is optional, and you can have Part A without Part B. Part B does usually have a small monthly cost, but to make the most from your health benefits we suggest a minimum of Part A, Part B, and Part D. If you are eligible, a Medicare Advantage plan will give you more choice and broader healthcare.

Medicare Supporting You With ALS or ESRD

There are no age restrictions for Medicare applicants with ALS or ESRD. As long as you are eligible for SSDI and meet the specific requirements you are eligible and can apply for Medicare

Depending on your condition or treatment, there may be a waiting period of a few months. This is much shorter than for other disabilities, so it is important to specify your condition when applying.

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