Extended Coverage of Immunosuppressive Drugs

As part of the final ruling issued by CMS on October 28, 2022, the Consolidated Appropriations Act will help extend coverage of immunosuppressive drugs for certain beneficiaries.

Kidney Transplant Patients and other Renal Dialysis Provisions

The current CMS rule allows for individuals with ESRD to become eligible for Medicare regardless of age or disability status. Medicare benefits are available to such individuals for 36 months and will then terminate. After 36 months, unless the individual is eligible for Medicare due to age or disability status, that person will lose Medicare coverage.

Those individuals losing Medicare coverage, are left to find other health insurance. Otherwise, they are left to cover the cost of immunosuppressive drugs 100%.

That was the past. And now, with CMS passing the CAA and as outlined in section 402 of Title IV of Division CC, the new rule now allows for the following.

Implementing Provisions of the Consolidated Appropriations Act (CAA)

• There will be no specific enrollment periods; if an individual is eligible, they can enroll (or disenroll) at any time.
• The benefit will only cover immunosuppressive drugs and will not include coverage for any other Part B benefits or services.
• An individual will be required to attest that they are not enrolled in, and do not expect to enroll in, certain other types of coverage (e.g., group health plan, TRICARE, or Medicaid that covers immunosuppressive drugs) and that they will provide notification to the Social Security Administration (SSA) within 60 days if they sign up for such other coverage (thereby ending their enrollment in the Part B-ID benefit).
• The monthly premium will be less than the standard Part B premium, and enrollees will not be subject to late enrollment penalties.  Enrollees will also have to pay the annual deductible. Once the deductible is met, enrollees pay 20% of the Medicare-approved amount for immunosuppressive drugs. 
• Individuals eligible for certain Medicare Savings Programs (MSPs) can have states   cover the immunosuppressive drug benefit premium, and for Qualified Medicare Beneficiaries (QMBs), co-insurance, deductibles and cost sharing as well

Medicare Qualifications Under 65

For those that do not qualify for Medicare under 65 due to ESRD, you still might be eligible.

People under 65 are eligible for Medicare if you are disabled for two consecutive years and collected social security benefits.

You can also qualify for Medicare if you have been diagnosed with Lou Gehrig’s Disease (ALS or amyotrophic lateral sclerosis).

Medicare Eligibility Requirement

Getting help is the easiest way to confirm your Medicare eligibility. Call us today at 866-633-4427 and one of our friendly, licensed agents will confirm if you qualify for Medicare.