Question

Mr. James has end stage renal disease (ESRD). He has been covered under Original Medicare but would like to know if he can enroll in a Medicare Advantage plan. What should you tell him?

Answer 1

The best answer to the question: Mr. James has end stage renal disease (ESRD). He has been covered under Original Medicare but would like to know if he can enroll in a Medicare Advantage plan. What should you tell him? Would be: That unfortunately he would not be applicable for Medicare Advantage due to his condition, but he would be first, elegible to all due coverage with his Original plan, and also, that he may seek to enroll in a Medicare Special Needs Plan, called an SNP, if it is available to him in his area.

These SNPs are specialized Medicare plans for people with disabling chronic conditions like Mr. James´s and they offer all coverage available in Medicare Plan A and B, as well as prescription coverage.

The only other way in which Mr. James could get coverage through a Medicare Advantage Plan would be if Mr. James had already been enrolled in the plan by an organization to which he had a link, like an employer. But since he doesn´t he could not have access to it.

Answer 2

If Mr. James has end stage renal disease (ESRD), it means that he has kidney impairment that appears to be irreversible and permanent and requires a regular course of dialysis or kidney transplantation to maintain life. Then I will tell him that he can enroll in a Medicare Advantage plan especially if he undergo dialysis or kidney transplant with certification from the attending physician that he is an ESRD patient.