ESRD – Medicare Coverage

We have noticed that there is quite a bit of confusion when it comes to identifying when Medicare becomes primary for an ESRD patient, so we’d like to help clarify.

For the first three months of the member’s dialysis treatment, the employer group health plan is the sole payor of health care bills.  Beginning the fourth month of treatment and extending for an additional 30 months, the employer group health plan will be the primary payor and Medicare will be the secondary payor, known as the coordination period.  At the end of the coordination period, Medicare will become the primary payor for the member’s health care bills.  At this time, it is very important for the case manager to notify INTERLINK that the patient has become Medicare primary, as this member is no longer eligible for INTERLINK’s coverage.