What is kidney disease?
Kidney disease means your kidneys are not working the way they should. Your kidneys are like filters. They help clean your blood, balance water in your body and help remove waste from your body.
What are the stages of kidney disease?
There are five stages of kidney disease. Stages 1–4 are all chronic kidney disease (CKD). That means the kidneys are damaged, but they still work. The stage number tells how much the kidneys can still do their job.
Stage 1 is the mildest. Stage 4 is the most serious before kidney failure. Stage 5 is the last stage. It is called End-Stage Renal Disease (ESRD), or kidney failure, when the kidneys can hardly work at all.
People with ESRD may be able to get Medicare, even if they are under 65.
There are two main ways to treat ESRD:
- Dialysis: Dialysis is a treatment for ESRD. A machine helps clean your blood when your kidneys cannot. You may do dialysis at a dialysis center, and sometimes at home.
If you do dialysis at home, Medicare coverage can start the month you start dialysis. If you get dialysis at a dialysis center, Medicare coverage can start on the first day of the fourth month after dialysis begins.
- Kidney transplant: A kidney transplant is surgery to give you a new kidney. A kidney doctor (called a nephrologist) takes care of people with kidney disease and helps plan for a transplant.
If you get a kidney transplant, Medicare coverage can start up to two months before you have the transplant. This start date depends on certain rules being met.
What parts of Medicare cover kidney disease medications, dialysis and transplants?
Each part of Medicare helps pay for certain kidney services:
Part A (hospital insurance):
This helps pay for hospital care. This can include a hospital stay for a kidney transplant.
Part B (medical insurance):
This helps pay for doctor visits and dialysis.
Part C (Medicare Advantage plans):
This covers everything in Part A and Part B, and it may cover prescription drugs.
This helps pay for prescription medicines that Part B doesn’t cover. It can include some medications people need after a kidney transplant.
What Aetna Medicare plans cover my kidney disease?
There are two kinds of Aetna Medicare plans that may help cover kidney disease:
Medicare Advantage (MA) plans
These plans are also called Part C. MA plans give you the coverage of Original Medicare (Parts A and B).
Some MA plans include coverage for your medications (Part D). These are called Medicare Advantage Prescription Drug plans (MAPD). With an MAPD plan, your medical and prescription drug coverage are in one plan. This helps cover your doctors and hospitals, plus your prescription drugs.
Learn more about MA plans
Chronic Condition Special Needs Plans (C-SNPs)
This is a type of Medicare Advantage plan for people with certain health needs, including some long-term (chronic) conditions, like kidney disease.
Common questions about kidney disease
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There are three plan options for Aetna Medicare Advantage plans.
- HMO: You need to use the plan’s doctors and hospitals. This is called staying in network, and it can help you save money. Going out-of-network can cost more.
- HMO-POS: Usually you need to use the plan’s doctors and places to get care, like hospitals or urgent care centers. You can sometimes go out-of-network, but it costs more.
- PPO: You can use any doctors and places to get care, like hospitals or urgent care centers. If you stay in network, you’ll pay less. If you go out-of-network, you’ll pay more.
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Before you enroll in a plan, make sure your doctor and dialysis center are in the plan’s network. Being in the network means the plan works with them. This can help you save money.
- Start with your ZIP code to see plans near you. Compare plans and enroll.
- Check the plan provider list to see if your kidney doctor and dialysis center are in network. Find providers.
- If you’re not sure, call your doctor’s office and ask what Medicare plans they take.
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Medicare Part B usually helps pay for home dialysis supplies. You can usually get this help if you:
- Have End-Stage Renal Disease (ESRD)
- Have a doctor say you need dialysis
- Have your dialysis at a dialysis center that Aetna Medicare approves
The dialysis center may send a nurse or helper to your home. They can also teach you how to do dialysis safely.
Durable medical equipment (DME)
Your plan may also cover supplies through the durable medical equipment (DME) benefit. This can include things like dialysis machines and supplies you use at home.
Monogram Health
Some Aetna Medicare Advantage plans have a program called Monogram Health. If you have kidney disease, they may visit you at home or talk with you by video. They can help you learn about your care and find resources and support.
Learn more about coverage for kidney dialysis
Ready to shop Aetna Medicare plans?
Enter your ZIP code to find Aetna Medicare plans in your area. Compare benefits, costs and drug coverage and see if your providers are in our network.
Already a member?
If you already have a plan:
- Log in to your secure member website
- Check your plan details to see what help is included.
- Contact Member Services if you have questions about your benefits.
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Disclaimer
The Aetna C-SNP is available to Medicare members who have at least one of the qualifying chronic conditions. To ensure a successful enrollment process, we’ll confirm with your healthcare provider that you have one of these eligible conditions. If verification of eligible condition is not received, involuntary disenrollment will occur.