If you are diagnosed with end-stage renal disease (ESRD), your coverage will change in a few important ways. NYSHIP and EBD will help you coordinate with Medicare to get you comprehensive coverage.
When diagnosed with ESRD, you should inform NYSHIP by calling EBD at 518-457-5754 or 1-800-833-4344. Your provider and/or dialysis center is responsible for submitting necessary documentation to the Social Security Administration.
Coverage Periods
After an ESRD diagnosis, Medicare and NYSHIP work together to cover your care.
If you are already Medicare-primary (meaning Medicare pays for care first), your coverage will not change. (If you return to work, speak with your HBA or Agency Contact.)
If you are instead NYSHIP-primary (meaning NYSHIP pays for care first), you will go through the following coverage periods. Each period begins on the first of the month.
1. Waiting Period
Lasts 3 months after dialysis begins
Primary Coverage: NYSHIP
Secondary Coverage: N/A
2. Coordination Period
Lasts 30 months
Primary Coverage: NYSHIP
Secondary Coverage: Medicare
3. Medicare-Primary Status
Ongoing
Primary Coverage: Medicare
Secondary Coverage: NYSHIP
Medicare coverage due to ESRD ends 12 months after dialysis concludes or 36 months after a successful kidney transplant.
Note: If you have NYSHIP coverage through COBRA and you become newly eligible for Medicare for any reason, your NYSHIP coverage will be terminated, and Medicare will become your only coverage. Contact your plan for specific details.