2023 Medicare Immunosuppressant Drug Coverage Changes

Medicare beneficiaries with End-Stage Renal Disease (ESRD) received a boost in coverage at the beginning of 2023. 

ESRD is one of the conditions that allow you to qualify for Medicare before reaching age 65, and Medicare Part B covers immunosuppressant drugs used to treat ESRD.

Medicare coverage ends 36 months after a kidney transplant for those under age 65, however. This means the immunosuppressant drugs are also only covered for 36 months after a kidney transplant or the end of dialysis. Kidney transplant recipients are then left to pay out of pocket or find other coverage after three years. 

But all that changed in 2023.

Under the new rules, Medicare benefits expire 36 months after a kidney transplant, but beneficiaries are allowed to keep their Medicare immunosuppressant drug coverage for the rest of their lives. 

Who Is Eligible for Medicare Immunosuppressant Drug Coverage?

If you are diagnosed with ESRD and need a kidney transplant or regular dialysis, you are eligible to begin receiving Medicare benefits provided you meet the work requirements for Social Security or the Railroad Retirement Board or are a spouse or dependent child of a person who does. 

After 36 months following a kidney transplant or 12 months after stopping dialysis, all benefits except for coverage of immunosuppressants will end.

Please note that Medicare coverage remains permanent following a kidney transplant or dialysis if you became eligible for Medicare before your kidney failure or if you turn 65 or acquire another disability after being diagnosed with ESRD.

As long as you do not have any other coverage for immunosuppressant drugs, you may continue that portion of Medicare Part B at the reduced premium indefinitely. If you have other insurance that covers the drugs (including Medicaid), you will not be eligible for continued Medicare coverage. 

You must have applied for Medicare prior to receiving your kidney transplant in order to be eligible for the extended coverage of immunosuppressants. 

What if My Medicare Coverage Has Already Expired?

Even if your Medicare coverage has already expired, you can enroll in the immunosuppressant Medicare drug benefit as long as you do not have any other insurance that provides coverage for the drug. 

How Much Does Medicare Immunosuppressant Coverage Cost?

Because these beneficiaries were not receiving any other Medicare Part B benefits, they were not required to pay the full Part B premium. Instead, they were charged a discounted premium of $97.10 per month in 2023. (The standard Part B premium for full benefits is $174.70 in 2024.) 

As is the case with full Part B benefits, higher income earners also paid a higher monthly premium for coverage of immunosuppressants only. 

While the Medicare Part B premium was discounted for these beneficiaries, the annual Part B deductible was not. Those who received only coverage of immunosuppressants still had to satisfy the full Medicare Part B deductible before any coverage of the drugs takes effect. In 2024, the Part B deductible is $240 per year. 

Once the deductible has been met, beneficiaries typically paid a 20% coinsurance of the Medicare-approved amount for the drugs. 

Can Beneficiaries Purchase Medicare Advantage or Medigap?

ESRD patients may only keep a Medicare Advantage (Medicare Part C) plan or a Medigap (Medicare Supplement Insurance) plan for as long as they are enrolled in Part A and Part B.

Medicare coverage for an ESRD patient expires 36 months after a kidney transplant or 12 months after stopping dialysis. 

How Do I Enroll in Extended Medicare Coverage of Immunosuppressants?

Call 1-800-MEDICARE (1-800-633-4227) or Social Security at 1-877-465-0355 to speak to a representative about enrolling in the extended 2023 Medicare coverage of immunosuppressant drugs.