Assisting a friend, who has ESRD and is on dialysis, navigate Medicare and private insurance benefits.

[Anonymous]

Some info:

- Began dialysis in December 2023

- SSDI Benefits began in June 2025

- Medicare premium deductions from SSDI benefits began in November 2025

- Currently on spouse's employer plan as a dependent

- Current age: 60

Questions:

- When (what date) does the 30-month coordination period end, where Medicare is primary and the employer health plan is secondary? Some confusing responses by case/social worker at the dialysis center.

- Now the twist: spouse has been informed that she and others will be laid off in November 2026. Spouse is looking for another position in the next few months and will hopefully land another position and will be on that employer's family health plan. Friend will be enrolled in that plan.

- If, for some reason, a new position is not found by November 2026, plan is to go on COBRA for family plan and/or find insurance in the marketplace (with similar great current coverage for family; understanding premiums/deductibles will be high).

- Does this make sense?

- OR, my friend can keep with current health insurance, but pay as a medicare gap/supplemental insurance plan for the other 20% coverage since Medicare will pay 80%. Friend has reached out to current insurance plan to walk through how this would work.

Any insight and/or suggestions would be greatly appreciated.

[Anonymous]

bump...any input?

[Anonymous]

30 month period starts when Medicare eligibility began (withdrawal of premium from SS check). If they lose primary coverage through no fault of their own, Medicare becomes primary. i don’t think that the coordination of benefits continues across payers (e.g., if they get another job and another insurer or go on the exchanges), I think they are now just in Medicare Fee For Service. You want Medicare as primary, it’s better coverage even though the dialysis providers don’t like it because Medicare pays less than private.

They can’t “drop Medicare” unless they pay back all SSDI amounts and unenroll in Social Security Disability Insurance. Plan to either remain in Medicare FFS as primary or switch to Medicare Advantage. I’m not sure you can get supplemental coverage (medigap) as an ESRD patient, or if you do it’s probably experience rated so you pay a ton.

Talk to your state health insurance (ship) organization. Everyone else has something to sell you.

https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship

[Anonymous]

Why would she buy insurance through the marketplace when she has Medicare? If her husband does not get a new job, she will become Medicare primary.

I always thought that Medicare is only secondary after 65 if one’s spouse is working and you’re under their insurance. If someone over 65 is Medicare secondary, I assume either they’re still working or their spouse does.

I have no idea what a 30 day coordination period is. I find those details confusing,