Revision 24-3; Effective Sept. 1, 2024
A person diagnosed with end-stage renal disease (ESRD) may be entitled to Medicare benefits. If the person receives a kidney transplant, Medicare entitlement ends after 36 months, unless the person is otherwise entitled to Medicare based on age or disability.
Medicare beneficiaries who lose Medicare eligibility after a kidney transplant may be eligible for the limited Medicare Part B immunosuppressive drug (Medicare Part B-ID) benefit. Medicare Part B-ID beneficiaries are not entitled to Medicare Part A, cannot be eligible for Medicare on another basis, and must not have any other comprehensive health care coverage that covers immunosuppressive drugs, such as Medicaid or the Children’s Health Insurance Program (CHIP). A Medicare Part B-ID beneficiary may be eligible for Community Attendant Services (CAS) or the Healthy Texas Women (HTW) program because these types of assistance do not cover immunosuppressive drugs.
The Medicare Part B-ID benefit only covers immunosuppressive drugs. Medicare does not cover any other items or services, including hospital stays, physician services, supplies or medications.
Eligible Part B-ID beneficiaries receive a new Medicare card that shows Medicare coverage for immunosuppressive drugs only.
Part B-ID beneficiaries with limited income and resources may be eligible for a Medicare Savings Program (MSP) even though they are not entitled to Medicare Part A. If the person meets all other eligibility requirements, the MSP will cover all or some of the person’s Medicare premiums, deductibles or coinsurance associated with the Part B-ID benefit.
Identification
Identify Medicare Part B-ID individuals by accessing State Online Query (SOLQ) or viewing the person’s Medicare card. In SOLQ, the Ledger Account File (LAF) code will display Active Title XVIII status only. Medicare Part B will reflect a start date with a premium amount lower than the standard Medicare Part B premium. The 2024 Part B-ID premium is $103.00. In addition, Medicare Part A will reflect a stop date with the option code None-No longer under renal disease provision.
Regular MSP and Part B-ID MSP in TIERS
Regular MSPs are Qualified Medicaid Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI-1) benefits based on entitlement for Medicare Part A. Part B-ID MSPs are QMB, SLMB or QI-1 benefits based on entitlement for Medicare Part B-ID. Part B-ID MSPs help with Medicare Part B-ID premiums, deductibles and co-insurance costs associated with immunosuppressive drugs only. A person approved for Part B-ID QMB does not receive regular QMB benefits. The Medicaid card for Part B-ID QMB recipients shows Part B-ID only in the upper righthand corner.
A regular MSP recipient who loses Medicare Part A entitlement based on ESRD and transfer to Part B-ID MSP receives a new Eligibility Determination Group (EDG) number in TIERS. The new EDG keeps the same review due date, packet sent date and packet received date as the old EDG, if the person is certified for the same type of assistance (TOA).