Medicare 2026

Kidney Failure and Job-Based Insurance: Understanding Medicare's 30-Month Coordination Period

If you qualify for Medicare because of permanent kidney failure (End-Stage Renal Disease, or ESRD) and you also have health coverage through an employer, a union, a retiree plan, or COBRA, a special set of rules decides which plan pays first. The centerpiece is a 30-month coordination period. Understanding how it works can help you avoid gaps in coverage and make a confident decision about when to sign up for Medicare.

What the coordination period is

Once you become eligible for Medicare based on permanent kidney failure, there is a 30-month window during which your employer group health plan (EGHP) or union plan continues to pay first and Medicare pays second. The clock starts the first month you would be eligible for Medicare — usually the fourth month of dialysis — even if you have not actually signed up for Medicare yet.

This primary-payer status for the group plan applies regardless of:

• the employer's number of employees,
• whether you are currently employed or already retired, and
• what the plan document says about paying secondary to Medicare.

In other words, during these 30 months the group plan can't push itself into secondary position just because you're Medicare-eligible.

After the coordination period ends, Medicare becomes the primary payer for all Medicare-covered services.

What Medicare pays during the coordination period

If you do enroll in Medicare during the 30-month window, Medicare may pay second when the group plan doesn't pay a covered service in full. Importantly, that secondary coverage applies to all Medicare-covered items and services — not only dialysis or other ESRD treatment.

The first three months of dialysis

Because ESRD-based Medicare generally cannot start until the fourth month of dialysis, your employer or union plan is usually the only payer during the first three months — unless you have other coverage, such as a spouse's plan. This is an important reason to understand exactly what your group plan covers before dialysis begins, if possible.

Should you delay signing up for Medicare?

Medicare.gov notes that if your group plan is going to pay most or all of your health costs, you may want to delay signing up for Medicare until the coordination period ends. Medicare's kidney booklet explains that your Part B premium won't be higher because of that delay while you have employer or union group health plan coverage based on your own or a spouse's current employment.

There is a catch to be aware of: the Part B Special Enrollment Period that lets people with job-based coverage enroll later without penalty does not apply to people who qualify for Medicare based on ESRD. If you're considering delaying, confirm the rules at Medicare.gov or by calling 1-800-MEDICARE first.

And if your group plan benefits are reduced or end during the coordination period, sign up for Medicare as soon as possible.

COBRA and prior Medicare eligibility

• If you have ESRD-based Medicare and COBRA, COBRA pays first and Medicare pays second during the 30-month period.
• If you already had Medicare because of age or a non-ESRD disability, whichever payer was primary (Medicare or your group plan) continues to be primary after you also become eligible because of ESRD.

A fresh 30 months each time

There is a separate 30-month coordination period each time you become entitled to Medicare based on permanent kidney failure. If circumstances change — for example, a transplant and then a later return to dialysis that re-establishes ESRD-based Medicare — a new coordination period starts.

Coverage choices after you do enroll

Once you are enrolled in Medicare, you'll weigh the same choices other beneficiaries face. Rather than compare plans head-to-head (which depends on where you live and what's offered), it helps to understand the two general paths:

• Original Medicare (Part A and Part B) plus, if you choose, a stand-alone Part D prescription drug plan and possibly a Medigap policy to help with cost-sharing. This path generally lets you use any provider that accepts Medicare, but Medigap rules for people under 65 or with ESRD vary.
• Medicare Advantage (Part C), which bundles Part A, Part B, and usually Part D into one plan from a private insurer. These plans often use networks and may include extra benefits, but rules and costs differ from Original Medicare.

Neither path is automatically better; it's a personal decision based on your providers, medications, budget, and travel needs.

Part D numbers to know

For 2027, the Part D out-of-pocket cap is $2,400 (up from $2,100 in 2026), and the maximum allowed Part D deductible is $700. The Part D base beneficiary premium — a national figure used to calculate the late-enrollment penalty — is $41.33 for 2027; actual plan premiums are set by each plan.

The 2027 Annual Enrollment Period runs October 15 – December 7, 2026, with changes taking effect January 1, 2027. Social Security announced a 3.6% cost-of-living adjustment for benefits payable beginning January 2027. The 2027 Part B standard premium and deductible, and the 2027 IRMAA income-related surcharges, have not yet been announced; CMS typically publishes them in the fall.

If you have Medicaid or Extra Help

Since 2025, people with Medicaid or Extra Help have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible individuals can join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Where can you get help with Medicare questions?

For personalized information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). These are the official sources for Medicare rules, enrollment windows, and the most current figures.