IU Health Plans Medicare Kidney Care (HMO)

IU Health Plans Medicare Kidney Care (HMO): A plan to meet your unique needs

Managing kidney disease can be a challenge. That’s why IU Health Plans has introduced the new Kidney Care (HMO) plan specifically designed for people diagnosed with chronic kidney disease (CKD) stage 3 (or higher) or end-stage renal disease (ESRD). Through our partnership with IU Health Physicians Kidney Health, we’ve created a plan with the benefits, support and convenience to meet your unique needs.

Discover the transformative power of our Kidney Care plan through the firsthand accounts and inspiring stories of patients who have experienced its remarkable benefits here.

Specialized benefits

Save more with our new Kidney Care Medicare Advantage plan

Only available to members under the care of a participating IU Health nephrologist* and in the IU Health Care Management Program.

• $0 copay for dialysis
• $0 copay for visits to most IU Health specialists (including nephrologists)
• $0 copay for transportation to plan-approved, health-related locations (limit of 50 miles each ride; no limit on number of rides)

*To find a list of participating nephrologists, please visit iuhealthplans.org/kidneydoctors.

Patients starting dialysis and not already on Medicare can enroll in our Medicare Advantage plan at the start of their fourth month of dialysis treatment. For patients choosing home dialysis, eligibility for our plan could begin as early as the first month.

Regardless of when you join, you’ll benefit from a specialized plan that is built on expert care coordination between doctors and service providers to help you stay well. 

Know before you enroll

Our Kidney Care (HMO) plan is for individuals who are under the care of a participating IU Health nephrologist and participate in the IU Health Care Management Program. 

In addition to benefits and services that address the special needs of people with kidney disease, IU Health Plans members enjoy customer service uniquely designed with them in mind. Our locally based Member Advocates answer questions about insurance coverage and providers, and can even help our members schedule doctor appointments—often in a single call.

Note to patients receiving dialysis: You may need to change dialysis clinics to be under the care of a participating nephrologist. This can be coordinated with the social worker at your current dialysis clinic. To ensure eligibility for all supplemental benefits, it is important that changes are made prior to enrolling in the Kidney Care Plan.

Our Kidney Care (HMO) plan offers:

• $0 Copay for dialysis*
• $0 Copay for visits to most IU Health specialists* (including nephrologists)
• $0 Copay for transportation to plan-approved, health-related locations* (limit of 50 miles each ride; no limit on number of rides)
• $0 Monthly premium
• $0 Rx (prescription) deductible
• $0 Copay for IU Health Primary Care visits
• $2,950 Maximum out-of-pocket protection
• Dental coverage—$1,000 per year for covered preventive and basic services
• Vision coverage—$250 allowance for frames and lenses or contacts

*Specialized benefits for those who qualify

Who is eligible to join?

Individuals must have both Medicare Part A and Part B to enroll with the IU Health Plans Medicare Advantage program. You must live in the service area, which includes these counties:

• Boone
• Hamilton
• Hancock
• Hendricks
• Johnson
• Madison
• Marion
• Morgan
• Shelby

Your coverage options 

If you have ESRD, you can choose either Original Medicare or a Medicare Advantage plan for your Medicare coverage. You don’t have to be 65 or older to be eligible for Medicare coverage, if you have ESRD.

When does coverage begin?

Eligibility for Medicare coverage based on ESRD works differently than other types of Medicare. If you’re eligible for Medicare based on ESRD and don’t sign up right away, your coverage could start up to 12 months before the month you apply. For example, if you become eligible for Medicare based on ESRD in February but don’t sign up for Medicare until November, your Medicare coverage will start in February (This is called retroactive coverage.).

If you're on dialysis:

• Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. This four-month waiting period will start even if you haven't signed up for Medicare.
• If you're covered by an employer group health plan, your Medicare coverage will start the fourth month of dialysis treatments. Your group health plan may pay the first three months of dialysis.
• Medicare coverage can begin as early as the first month of a regular course of dialysis treatments if you meet all the following conditions:
  • You participate in a home dialysis training program offered by a Medicare-certified training facility during the first three months of your regular course of dialysis.
  • Your doctor expects you to finish training and be able to do your own dialysis treatments at home.
  • You maintain a regular course of dialysis throughout the waiting period that would otherwise apply.

If you’re getting a kidney transplant: 

• Medicare coverage can begin the month you’re admitted to a Medicare-certified hospital for a kidney transplant (or for healthcare services that you need before your transplant) if your transplant takes place in that same month or within the next two months.
  • For example: If you are scheduled to get a kidney transplant on April 10, your coverage will begin in April. If your transplant is delayed until May or June, your coverage will still begin in April.
• If your transplant is delayed more than two months after you’re admitted to the hospital (for the transplant or for healthcare services you need before your transplant), Medicare coverage can begin two months before your transplant. 
  • For example: If you are admitted to the hospital on Feb. 15 for some tests before your kidney transplant that is coming up on March 24, but your transplant is delayed until June 8, then your coverage begins in April (two months prior to the month of your transplant).

When does coverage end?

If you have Medicare only because of permanent kidney failure, Medicare coverage will end:

• 12 months after the month you stop dialysis treatments.
• 36 months after the month you have a kidney transplant.

Your Medicare coverage will resume if:

• You start dialysis again, or you get a kidney transplant within 12 months after the month you stopped getting dialysis.
• You start dialysis or get another kidney transplant within 36 months after the month you get a kidney transplant.

We’re here to help you enroll 

Our Medicare Advantage experts are standing by to help you enroll or answer your questions. Call us at 866.493.2873 for a personal consultation. Need more details? Check out our free Benefits Guide at IUHealthplans.org/Kidney to learn more.