Medicare Extends Coverage of Immunosuppressant Drugs in 2023
- Medicare beneficiaries with kidney failure will receive expanded coverage of immunosuppressant drugs in 2023. Learn how the changes could affect your Medicare drug coverage.
Medicare beneficiaries with End-Stage Renal Disease (ESRD) are set to receive a boost in coverage beginning in 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 changes beginning in 2023.
Under the new rules, Medicare benefits will still expire 36 months after a kidney transplant, but beneficiaries will be 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 will not be receiving any other Medicare Part B benefits, they are not required to pay the full Part B premium. Instead, they will be charged a discounted premium of $97.10 per month in 2023. (The standard Part B premium for full benefits is $164.90 in 2023.)
As is the case with full Part B benefits, higher income earners will also pay a higher monthly premium for coverage of immunosuppressants only.
While the Medicare Part B premium is discounted for these beneficiaries, the annual Part B deductible is not. Those receiving only coverage of immunosuppressants must still satisfy the full Medicare Part B deductible before any coverage of the drugs takes effect. In 2023, the Part B deductible is $226 per year.
Once the deductible has been met, beneficiaries will typically pay 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.