Talking Medicare is the Senior Marketing Specialists weekly topic sheet. Information for agents to know for their clients, staff, and industry.

End Stage Renal Disease (ESRD) and Medicare

You can get Medicare no matter how old you are if your kidneys no longer work, you need regular dialysis, or have had a kidney transplant, and one of these applies to you:

  • You’ve worked the required amount of time under Social Security, Railroad Retirement Board, or as a government employee.
  • You’re already getting or are eligible for Social Security or Railroad Retirement benefits.
  • You’re the spouse or dependent child of a person who meets either of the requirements listed above.

Kidney failure, also called end-stage renal disease (ESRD), is the last stage of chronic kidney disease. When your kidneys fail, it means they have stopped working well enough for you to survive without dialysis or a kidney transplant.

The most common causes of ESRD are diabetes and high blood pressure since they can affect your kidneys. https://www.medicare.gov/people-like-me/esrd/esrd.html

Medicare Advantage and ESRD – Medicare Advantage (MA) Plans are generally not available to people with ESRD. For most people with ESRD, Original Medicare is usually the only option. There are exceptions that allow an individual to keep a Medicare Advantage if you are diagnosed after you have a MA plan.

Find more details at this site: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/esrd-and-medicare-advantage-plans.html

Medicare Supplement and ESRD (Under 65) – If you have ESRD, you may not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law doesn’t require insurance companies to sell Medigap policies to people under 65.

Medicare Supplement and ESRD (Turning 65) – Individuals with ESRD can apply for coverage during their open enrollment period when turning 65.

Part D and ESRD – Part D, Medicare prescription drug coverage, is available to all people with Medicare, including those entitled because of ESRD or a disability. Additional information can be found on MedicareInteractive.org: https://www.medicareinteractive.org/get-answers/medicare-covered-services/medicare-and-end-stage-renal-disease-esrd

Who is the U.S. Railroad Retirement Board?

The Railroad Retirement Board (RRB) is an independent agency in the executive branch of the Federal Government. The RRB’s primary function is to administer comprehensive retirement-survivor and unemployment-sickness benefit programs for the nation’s railroad workers and their families, under the Railroad Retirement and Railroad Unemployment Insurance Acts.  https://secure.rrb.gov/

Medicare for Railroad Workers and Their Families

The Medicare program covers railroad workers just like workers under social security. Railroad retirement payroll taxes include a Medicare hospital insurance tax just like social security payroll taxes.

Find out more in this helpful booklet: http://www.rrb.gov/forms/opa/rb20/rb20.asp#

Tax Guide for Seniors

The purpose of this publication is to provide a general overview of selected topics that are of interest to older taxpayers.


“Medicare Part A.   If you are covered under social security (or if you are a government employee who paid Medicare tax), you are enrolled in Medicare Part A. The payroll tax paid for Medicare Part A isn’t a medical expense. If you aren’t covered under social security (or weren’t a government employee who paid Medicare tax), you can enroll voluntarily in Medicare Part A. In this situation you can include the premiums you paid for Medicare Part A as a medical expense.

Medicare Part B.   Medicare Part B is a supplemental medical insurance. Premiums you pay for Medicare Part B are a medical expense. Check the information you received from the Social Security Administration to find out your premium.

Social Security beneficiaries may quickly and easily obtain various information from SSA’s website with a my Social Security account, including getting a replacement SSA‐1099 or SSA‐1042S. For more information, see Obtaining Social Security information , earlier.

Medicare Part D.   Medicare Part D is a voluntary prescription drug insurance program for persons with Medicare Part A or Part B. You can include as a medical expense premiums you pay for Medicare Part D.” – Excerpt from Publication 554 (2015), Tax Guide for Seniors

You Cannot Use the SEP for Service Area Reductions until December 8th

When completing Medicare Advantage applications, you cannot use the SEP for SAR’s until that enrollment period opens. If an individual losing their plan wants to apply for a new plan during AEP, use the election period code AEP.

The Special Enrollment Period for discontinued plans (or Service Area Reductions) will start on December 8th and continue through February 28, 2017, with your new 2017 plan coverage beginning on the first day of the month following enrollment.

Medicare Supplement Guarantee Issue Right due to SAR:

If You’re in a Medicare Advantage Plan, and your plan is leaving Medicare, stops giving care in your area, or you move out of the plan’s service area.

  • You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.
  • You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.
  • You can/must apply for a Medigap policy as early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.


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