Medicare With Kidney Failure or ALS: When Coverage Starts

With kidney failure, Medicare usually starts on the first day of the fourth month of dialysis, at any age. With ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease), Medicare starts the month your Social Security disability benefits begin. Neither has the usual 24-month wait.

Key takeaways

• Kidney failure: Medicare usually begins the first day of the fourth month of regular dialysis.
• Home dialysis training in the first three months can move the start to the first month of dialysis.
• A kidney transplant can start coverage the month you enter a Medicare-approved hospital for it.
• ALS: Medicare begins the same month your Social Security disability benefits begin.
• Sign-up differs: with kidney failure you must apply. With ALS, Part A and Part B start on their own.

Who can get Medicare for kidney failure?

Medicare uses the term ESRD (end-stage renal disease, meaning your kidneys have stopped working for good). You need regular dialysis or a kidney transplant. Age does not matter.

You also need a link to the work system. You qualify if you have enough work credits under Social Security, the Railroad Retirement Board, or as a government employee. You also qualify if you already get Social Security or railroad benefits.

The work can be someone else's. A spouse or a dependent child of a worker who meets the rule can qualify too. Learn how credits add up in Medicare Part A Premium: Work Credits and Who Pays Nothing.

You must also be a U.S. citizen or national, a green card holder, a Cuban-Haitian entrant, or a COFA migrant (a person lawfully living here under a Compact of Free Association). If you are unsure, ask Social Security or 1-800-MEDICARE.

When does kidney failure coverage begin?

For regular dialysis at a center, Medicare starts on the first day of the fourth month. Say your dialysis starts on March 10. March is month one, so Medicare starts on June 1.

Home dialysis training can move the date up. If you join a training program at a Medicare-approved facility in your first three months, coverage can start the first month of dialysis. You must expect to finish training and do your own dialysis.

A transplant has its own rule. Coverage can start the month you enter a Medicare-approved hospital for the transplant or care before it. The transplant must happen that month or within the next two months.

If the transplant is delayed more than two months, coverage starts two months before the month of the transplant.

How do the start dates compare?

The table shows one pattern. Home training and a transplant can start coverage sooner than center dialysis alone. ALS coverage follows your disability benefits, not a dialysis clock.

How does Medicare start with Lou Gehrig's disease?

People under 65 on disability benefits usually wait 24 months before Medicare begins. That wait is explained in Medicare Before 65 With a Disability: The 24-Month Wait. People with ALS skip it.

With ALS, Medicare starts the month your Social Security Disability Insurance (SSDI, monthly payments for workers who can no longer work) begins. A 2020 law also removed the five-month wait for SSDI for people with ALS.

So the steps are short. Apply for SSDI at ssa.gov or by phone. Once you are approved, Medicare comes with it.

Do you have to sign up yourself?

With ALS, no. Social Security enrolls you in Part A and Part B and mails your Medicare card. You can turn down Part B. If you keep it, the 2026 standard Part B premium is $202.90 a month; it is set each year.

With kidney failure, yes. You apply through Social Security. Your dialysis or transplant center fills out a medical form, the ESRD Medical Evidence Report, to show your diagnosis.

If you apply late, kidney failure coverage can sometimes be back-dated up to 12 months. Ask Social Security to use your real start date when you apply.

Part A covers hospital stays, including a transplant stay. In 2026, the Part A deductible is $1,736 per benefit period; it can change each year. Part B covers outpatient dialysis and doctor visits, with a 2026 deductible of $283 that is set each year.

What if you have job-based health insurance?

With kidney failure, a job-based or union group health plan pays first for 30 months. This is called the coordination period. Medicare pays second during that time.

After 30 months, Medicare pays first and the job plan pays second. The 30 months start when you could first get Medicare, even if you have not signed up yet.

This rule is only for kidney failure. With ALS, who pays first depends on your employer's size and other rules. Your plan's benefits office can tell you its order of payment.

Can you join a Medicare Advantage or drug plan?

Yes. Since 2021, people with kidney failure can join Medicare Advantage plans (private plans that cover Part A and Part B services). Plan networks, costs and rules vary by location and carrier. A plan's out-of-pocket limit covers Part A and B services only, not drugs or premiums.

Drug costs matter with dialysis and transplants. In 2026, Part D drug plans cap your out-of-pocket drug costs at $2,100 a year; the cap is set yearly. A plan's deductible can be up to $615 in 2026, and some plans charge less.

If money is tight, look into Extra Help (a program that lowers drug costs). In 2026, the income limit is $23,475 a year for one person. See Extra Help (LIS): Do You Qualify, and Its Value.

Medigap (a policy that helps pay Original Medicare's share of costs) is harder under 65. Federal law does not make insurers sell it to people under 65. Some states do, and your State Health Insurance Assistance Program (SHIP) can say what yours requires.

When does kidney failure coverage end?

If kidney failure is your only reason for Medicare, coverage can end. It ends 12 months after the month you stop dialysis. After a transplant, it ends 36 months after the transplant month.

Coverage comes back with no new wait if you restart dialysis or get a transplant within those time frames.

After a transplant, you may be able to keep a Part B benefit that pays only for your anti-rejection drugs. This applies if you have no other health coverage. Ask Social Security about it before your 36 months end.

With ALS, Medicare stays as long as you get disability benefits. At 65, your Medicare continues based on age.

Check your own dates at Medicare.gov or by calling 1-800-MEDICARE. Plan details vary by location and carrier.

Have questions? Call 1-877-443-3251 to talk it through with a licensed insurance agent. You never pay the agent; the plans they represent do, and the decision stays yours.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information.