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Medicare and Kidney Failure: What ESRD Dialysis Coverage Actually Pays in Sioux Falls, 2026
A kidney failure diagnosis starts a 30-month countdown, a nearly irreversible-feeling insurance decision, and an uncapped 20% coinsurance bill — usually in the same week, and usually with almost nobody explaining any of it in plain language.
The bottom line
- Medicare covers dialysis and kidney transplants at any age — you don't have to be 65 — but in-center coverage typically doesn't start until the 4th month of treatment unless you train for home dialysis.
- The 30-month coordination period decides whether your employer plan or Medicare pays first if you're still working, and it starts counting the month you first qualify, whether or not you've enrolled yet.
- Since 2021, ESRD patients can choose Medicare Advantage — enrollment among ESRD beneficiaries nationally rose from 24.8% to 43.1% in two years, but network fit with your specific dialysis center matters more than for almost any other diagnosis.
- Original Medicare's 20% dialysis coinsurance has no yearly ceiling — using CMS's 2026 payment rate, a standard 3-times-a-week schedule works out to roughly $8,789.35 a year in coinsurance alone.
- South Dakota gives under-65 disabled and ESRD Medicare enrollees a real, genuine advantage: a 6-month Medigap guaranteed-issue window, the same protection people get at 65.
The short answer: Medicare covers dialysis and kidney transplant care at any age, but exactly when coverage starts, who pays first, and how much you owe depends on a set of rules almost nobody explains before the first treatment — the 30-month coordination period, the 2021 rule change that opened Medicare Advantage to ESRD patients, and an uncapped 20% coinsurance bill under Original Medicare. If you or someone you love just heard the words "kidney failure" and "dialysis" from a doctor, this guide walks through what Medicare actually pays for, what it costs in 2026, and a genuinely useful advantage South Dakota residents under 65 have that most states don't guarantee.
Every figure below comes from a source fetched directly for this article: Medicare.gov's ESRD coverage rules, the Medicare.gov 2026 costs fact sheet, the CMS 2026 ESRD Prospective Payment System final rule, NIDDK's national kidney disease statistics, a peer-reviewed study of CMS enrollment data, and the South Dakota Division of Insurance. No invented numbers, and every figure is labeled with the year or period it actually covers.
How ESRD Medicare coverage actually works
End-stage renal disease, or ESRD, is the medical term for permanent kidney failure — the point where a person needs regular dialysis or a kidney transplant to survive. It's one of only three ways to qualify for Medicare outside of turning 65: the others are collecting Social Security disability benefits for at least 24 months, or having amyotrophic lateral sclerosis (ALS). Unlike those two, ESRD-based Medicare has its own separate set of eligibility and timing rules, and they trip up more families than almost any other corner of Medicare — not because the rules are unusually complicated, but because nobody hands you a plain-language explanation of them at the exact moment you're absorbing a diagnosis.
To qualify for Medicare based on ESRD, your kidneys have to have failed to the point that you need regular dialysis or a transplant, and you generally need to meet Social Security's work-credit requirement — through your own work history, a spouse's, or, if you're a dependent, a parent's. Once that's true, Medicare coverage isn't limited to any specific age. A 42-year-old on dialysis and an 81-year-old on dialysis qualify under the exact same federal rule.
The three paths to ESRD Medicare coverage — and why the start date changes
The path you take into ESRD Medicare determines when your coverage actually begins, and the difference is bigger than most people expect:
| Path | What's required | When coverage starts |
|---|---|---|
| In-center dialysis | Kidney failure requiring regular dialysis, plus Social Security work-credit history (yours, a spouse's, or a parent's if you're a dependent) | The first day of the 4th month of dialysis treatment |
| Home dialysis | Same work-credit rule, plus you complete a home dialysis training program at a Medicare-certified facility and are expected to finish training and self-administer treatments | As early as the first month of dialysis — no 3-month wait |
| Kidney transplant | Same work-credit rule; hospital admission for a transplant expected within 2 months | The month you're admitted for the transplant (or up to 2 months before, if the transplant is delayed) |
Source: Medicare.gov — End-Stage Renal Disease (ESRD).
Notice the gap between the first two rows: someone starting standard in-center dialysis waits three full months before Medicare coverage kicks in, while someone who completes home dialysis training at a Medicare-certified facility can have coverage from their very first month of treatment. That's not a minor technicality — three months of dialysis without Medicare picking up its share is a real financial exposure, and it's exactly the kind of detail a busy nephrology practice may mention once, in passing, during an already overwhelming appointment. If home dialysis is even a possibility for you medically, it's worth asking your care team about the training program specifically, with this coverage-timing rule in mind.
Just received a kidney failure diagnosis?
Tell us where you are in the process — new diagnosis, already on dialysis, weighing a transplant — and we'll help you understand what your current coverage does and doesn't protect, and where South Dakota's rules genuinely work in your favor. Free, local, no pressure.
Talk it through →The 30-month coordination period, in plain dollars
If you're still working when you're diagnosed — or a spouse's job covers you — the single most consequential ESRD Medicare rule is the 30-month coordination period. Here's how it actually works, without the insurance-industry phrasing:
Source: Medicare.gov — End-Stage Renal Disease (ESRD).
Two things about this rule catch people off guard. First, the clock starts the month you become eligible, not the month you actually sign up — so someone who delays enrolling in Medicare because "my job's insurance is handling it" can still be burning coordination-period months without realizing it. Second, the rule ignores employer size entirely. Every other part of Medicare's rules around working past 65 hinges on whether your employer has 20 or more employees; ESRD's coordination period doesn't care — it's 30 months either way.
Many people in this position still choose to enroll in Medicare right away, even though their employer plan is paying first. The reason: Medicare as a secondary payer can pick up deductibles, copays, and coinsurance your employer plan leaves on the table, and having both in place from day one means nothing falls through the gap between them while you're sorting out the bigger decision of what happens after the 30 months end.
Medicare Advantage or Original Medicare: the 2021 rule change that matters right now
For decades, people with ESRD were almost entirely shut out of Medicare Advantage and funneled into Original Medicare, with only narrow exceptions. That changed on January 1, 2021, when the 21st Century Cures Act's ESRD provision took effect, opening Medicare Advantage to essentially all ESRD beneficiaries for the first time. It's a genuinely recent change — recent enough that a lot of the general advice floating around online still assumes the old, more restrictive rule.
The real-world shift was fast and well documented. A peer-reviewed study using CMS's own Medicare Master Beneficiary Summary File tracked what happened next:
Share of Medicare ESRD beneficiaries enrolled in Medicare Advantage, nationally. Source: PMC (National Library of Medicine) — Medicare Advantage Enrollment Following the 21st Century Cures Act in Adults With End-Stage Renal Disease, using CMS Medicare Master Beneficiary Summary File data, December 2020 – December 2022.
By December 2022, 211,896 of 491,611 Medicare ESRD beneficiaries nationally — 43.1% — were enrolled in a Medicare Advantage plan, up from 24.8% two years earlier. That's not a small trend; it's nearly doubling in two years, faster than CMS itself had projected.
Whether that trend fits your situation is a genuinely individual question, and the answer turns almost entirely on one thing: network. Medicare Advantage plans cover dialysis — every plan does, by federal requirement — but "covers dialysis" doesn't mean your specific dialysis center, your specific nephrologist, or a transplant center you're already working with is in that plan's network. For most conditions, an out-of-network specialist is an inconvenience. For dialysis, which typically happens three times a week on a fixed schedule, an out-of-network center is a much bigger disruption to work around. Before choosing Medicare Advantage over Original Medicare with a Medigap supplement — or the reverse — the network question deserves more weight than the premium.
One coverage detail changed alongside the Cures Act's enrollment provision: since January 1, 2021, Medicare Advantage plans are no longer financially responsible for kidney organ acquisition costs tied to a transplant. Those costs are covered under Original Medicare's fee-for-service program instead — even for someone enrolled in a Medicare Advantage plan for everything else. It's a technical point, but worth knowing if a transplant is part of your care plan.
What in-center dialysis actually costs you in 2026
Medicare doesn't pay dialysis facilities a per-service fee the way it does for many other kinds of care. Instead, CMS sets a single bundled per-treatment payment rate each year — the ESRD Prospective Payment System (PPS) rate — that covers the dialysis session plus most related drugs, lab tests, and supplies in one number.
Source: CMS — Calendar Year 2026 End-Stage Renal Disease Prospective Payment System Final Rule (Fact Sheet), published November 20, 2025, effective January 1, 2026.
That base rate is what Medicare pays the facility — not what you owe. Under Original Medicare, you're responsible for 20% coinsurance on the Medicare-approved amount after your Part B deductible ($283 in 2026), and that 20% has no annual ceiling on its own. Run the math on a standard 3-times-a-week hemodialysis schedule:
| Input | Figure |
|---|---|
| Treatments per week | 3 |
| Treatments per year | 156 |
| 2026 base rate per treatment | $281.71 |
| Total Medicare-approved amount for the year | $43,946.76 |
| Your 20% coinsurance, for the year | $8,789.35 |
This is an illustrative calculation built from the CY2026 ESRD PPS base rate above and a standard treatment schedule — not a separately published CMS total. It doesn't include your Part B deductible, other Part B services, or any Part D drug costs.
Roughly $8,789.35 a year in coinsurance alone, before a single office visit, lab test outside the bundle, or prescription is counted — and under Original Medicare with no supplement, that number has no ceiling. This is exactly the gap a Medigap policy is built to close, or, on the Medicare Advantage side, the gap a plan's annual out-of-pocket maximum caps instead. Which approach fits better depends on your network needs, your other health costs, and your budget for a monthly premium versus a larger, uncapped bill — a conversation worth having with someone who isn't also trying to sell you a specific answer.
South Dakota's under-65 Medigap window: a real local advantage
Here's a piece of good news that rarely gets mentioned in general Medicare content, because it isn't true everywhere. Federal law guarantees Medigap access without medical underwriting during your 6-month window when you turn 65 — but it does not guarantee that same right to people who qualify for Medicare before 65 because of disability or ESRD. Whether you get that protection at all depends entirely on your state.
South Dakota is one of the states that extends it. According to the South Dakota Division of Insurance, beneficiaries under 65 who qualify for Medicare by reason of disability — which includes ESRD-based eligibility — get a 6-month open enrollment period beginning the date of enrollment in Part B Medicare, during which Medicare supplement insurance can be obtained regardless of health condition. That's the 6-month open enrollment period South Dakotans get once they turn 65 — not a lesser version of it.
The window starts on a date that isn't your birthday
Unlike the age-65 Medigap window, this one starts the day you enroll in Part B — a date that can slip by unnoticed if you're focused on dialysis logistics rather than paperwork. Mark it as soon as your Part B coverage is confirmed, because once the 6 months close, South Dakota insurers can medically underwrite a Medigap application and decline coverage based on your health.
This matters most for exactly the coinsurance math above: a Medigap policy bought during that guaranteed-issue window closes the uncapped 20% dialysis coinsurance gap without anyone asking about your kidney diagnosis first. Outside that window, an insurer reviewing an ESRD applicant for Medigap coverage in South Dakota can decline the application entirely — which is exactly why knowing this rule exists, and exactly when the clock starts, is worth more than almost any other single fact in this guide if you're under 65.
Home dialysis and kidney transplant coverage
Home dialysis — whether peritoneal dialysis or home hemodialysis — is covered on the same underlying terms as in-center treatment: 80% by Part B after your deductible, 20% coinsurance owed by you. The advantage, beyond convenience and often better clinical outcomes for the right candidate, is the faster coverage start date covered above: as early as your first month of treatment instead of the standard 3-month wait, once you complete a Medicare-certified training program.
Kidney transplant coverage works differently. Medicare covers the transplant surgery itself, the hospital stay, and immunosuppressant drugs needed to prevent organ rejection afterward, as long as the transplant is performed at a Medicare-approved transplant center. Coverage typically starts the month you're admitted for the transplant, or up to 2 months before if the surgery ends up delayed past that point. Immunosuppressant drug coverage afterward runs through Part B in specific circumstances or Part D more broadly — a detail worth confirming directly with your transplant center's financial counselor, since getting it wrong can mean an unexpected pharmacy bill during recovery, when it's the last thing a family wants to sort out.
As noted above, since 2021 the organ acquisition costs tied to a kidney transplant are covered under Original Medicare's fee-for-service program even for someone enrolled in a Medicare Advantage plan — one of the few places where your "everyday" plan and your transplant coverage genuinely split apart administratively, even though neither the transplant center nor most patients notice the difference day to day.
Weighing Medicare Advantage against Original Medicare and a Medigap plan?
You can absolutely work through this yourself. Most people we talk with want a second pair of eyes specifically on whether their dialysis center and nephrologist are in-network for the plans we offer in the Sioux Falls area — that's the detail worth double-checking before you commit.
Check your network fit →Finding dialysis care in the Sioux Falls area
Sioux Falls' two competing health systems both run dialysis programs, alongside a national dialysis provider with its own local presence:
- Avera Dialysis Sioux Falls — Avera Health, 1325 S. Cliff Ave., Plaza 3, Sioux Falls, SD
- DaVita Sioux Falls Dialysis — DaVita (national provider), 2326 W. 69th St., Sioux Falls, SD
- DaVita Sioux Falls At Home — DaVita (national provider), Sioux Falls, SD — home dialysis program
This is a starting list of names families ask about, not a ranking or an endorsement of one provider over another. Medicare.gov's own Care Compare tool is the right place to check a specific facility's current quality measures before choosing where to receive treatment. The system question matters for a second reason beyond the dialysis center itself: if your broader Medicare Advantage plan is built around one hospital system's network — Sanford's Align plans, for example — that same network logic extends to your nephrologist, your vascular access surgeon, and any hospital-based care tied to your kidney disease, not just the dialysis chair itself. We cover that broader network dynamic in our Sanford vs. Avera network guide.
Sanford USD Medical Center and Avera McKennan Hospital both hold strong CMS Hospital Compare ratings, relevant if a hospitalization becomes part of your kidney care at any point:
| Hospital | CMS Star Rating | System |
|---|---|---|
| Sanford USD Medical Center | ★★★★★ (5/5) | Sanford Health |
| Avera McKennan Hospital & University Health Center | ★★★★ (4/5) | Avera Health |
| Sioux Falls VA Medical Center | ★★★★★ (5/5) | U.S. Dept. of Veterans Affairs |
Source: CMS Hospital Compare — Overall Star Ratings.
When ESRD Medicare coverage ends — and restarts
ESRD-based Medicare eligibility isn't automatically permanent the way turning-65 eligibility is. Coverage tied specifically to your ESRD diagnosis ends 12 months after you stop dialysis, or 36 months after a successful kidney transplant. If you go back on dialysis within 12 months, or receive a new transplant within 36 months of the last one, ESRD Medicare coverage — and potentially a fresh 30-month coordination period — can start again.
This is where it's worth remembering that Medicare eligibility can overlap. Someone whose ESRD-based coverage would otherwise end after a transplant may still qualify for Medicare on another basis entirely — because they've since turned 65, or because they separately qualify through Social Security disability. If more than one path applies to you, coverage generally continues on whichever basis keeps you eligible, so ending ESRD-specific coverage doesn't necessarily mean losing Medicare altogether. This is genuinely one of the more tangled corners of Medicare's rules, and it's worth confirming your specific timeline directly with Social Security or 1-800-MEDICARE rather than assuming.
A real scenario, worked through
Say a 58-year-old Sioux Falls resident, still working full-time with employer coverage, is diagnosed with kidney failure and starts in-center hemodialysis. Her ESRD Medicare eligibility clock starts immediately, but her actual coverage doesn't begin until the fourth month of treatment. During that gap, and for the 30 months after, her employer plan pays first on every dialysis bill — but she chooses to enroll in Medicare as soon as she's eligible anyway, so Medicare can pick up whatever her employer plan's deductibles and coinsurance leave behind.
Eighteen months in, she's laid off and loses her employer coverage entirely, with 12 months still left in her 30-month coordination period. Because she already enrolled in Medicare rather than waiting, there's no coverage gap — Medicare simply becomes her only payer from that point forward, months ahead of the 30-month mark, instead of primary coverage suddenly needing to be found from scratch during an already difficult stretch. Because she's under 65 and now needs supplemental coverage to handle the uncapped 20% coinsurance on her own, she confirms she's still inside South Dakota's 6-month under-65 Medigap window from her original Part B enrollment date — and if she is, she can buy a Medigap policy without being medically underwritten for her kidney diagnosis.
The single decision that mattered most in this scenario wasn't which plan she eventually picked — it was enrolling in Medicare early, before she needed it as her only coverage, instead of waiting until a layoff forced the question.
What to do this week
None of this requires becoming a health policy expert. It requires a short list of direct questions, asked in order:
| Step | What to actually do |
|---|---|
| Name which clock you're actually on | "Am I inside my 30-month coordination period?" and "Have I already enrolled in Medicare Part A and B?" are two different questions with two different answers. Get both dates in writing from your dialysis center's social worker or billing office before you decide anything else. |
| Ask your employer plan and Medicare which one pays first, in writing | During the 30-month coordination period your group health plan pays first regardless of how large your employer is. Get this confirmed by both your HR benefits office and 1-800-MEDICARE — don't rely on a single verbal answer from either side. |
| Confirm your nephrologist and dialysis center are in-network before you pick a plan | If you're weighing Medicare Advantage, call the plan directly and ask about your specific dialysis center and nephrologist by name, not just "do you cover dialysis" — every plan covers dialysis; not every plan's network includes your clinic. |
| If you're under 65, ask South Dakota's Division of Insurance about your 6-month Medigap window | This window opens the date you enroll in Part B — not your birthday — and it's easy to miss if nobody tells you it exists. Once it closes, insurers can decline you for a pre-existing condition. |
| Run the 20%-coinsurance math against your own treatment schedule | Original Medicare's Part B coinsurance has no yearly ceiling. A Medigap plan or a Medicare Advantage plan's out-of-pocket maximum are the two ways that gap gets capped — ask which one your current coverage actually does. |
| Ask about Extra Help and South Dakota's Medicare Savings Programs before assuming you don't qualify | Dialysis patients are disproportionately likely to qualify for federal low-income subsidies because ESRD often arrives alongside reduced work income. It costs nothing to ask, and the income limits are higher than most people guess. |
If you're an adult child helping a parent through this, ask to be added as an authorized representative on their Medicare and Social Security accounts as early as possible — most of the calls above go faster once you can legally speak on their behalf directly, instead of relaying answers back and forth secondhand.
What to watch heading into 2027
- Confirm your Medicare Advantage plan's dialysis network for 2027 during AEP (Oct 15–Dec 7, 2026) — a plan's contracted dialysis facilities can change year to year, same as its hospital network.
- Watch your Annual Notice of Change for any shift in how your plan handles ESRD-related care — we cover how to read the full document in our ANOC guide.
- Track your own 30-month coordination period date on a calendar, not just in memory — it's the single date that determines who pays first, and it doesn't send you a reminder.
- If you're under 65, know your South Dakota Medigap window's exact start and end date — and if it's already closed, ask about Medicare Advantage's out-of-pocket maximum as your alternative way to cap the 20% coinsurance gap.
- If a transplant becomes part of your plan, confirm with the transplant center's financial counselor how your specific coverage handles organ acquisition costs and post-transplant immunosuppressant drugs before the surgery, not after.
Big Sioux Benefits compares the plans we offer in the Sioux Falls area against real situations like this one — not just premiums. Understanding exactly where your current coverage's dialysis and transplant protection actually starts and stops is worth doing before a bill arrives that doesn't match what you expected.
Important
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or SHIINE, South Dakota's State Health Insurance Program (SHIP), to get information on all of your options. Big Sioux Benefits is a licensed independent insurance agency, not connected with or endorsed by the United States government or the federal Medicare program. This article is education, not medical, legal, or financial advice — confirm your specific situation with a licensed agent, Social Security, or Medicare.gov.
How we know all this: Big Sioux Benefits runs every article through a data desk that cross-references Medicare.gov's published ESRD coverage rules, CMS's 2026 ESRD Prospective Payment System final rule, CMS's 2026 Medicare costs fact sheet, NIDDK's national kidney disease statistics, a peer-reviewed study built on CMS's own Medicare Master Beneficiary Summary File data, and the South Dakota Division of Insurance's current Medigap rules — built by Strategic AI Architects. Every figure here traces to a source fetched directly for this article, with the data year stated wherever it isn't the current plan year. This is education, not medical, legal, or insurance advice; confirm your specific situation with a licensed agent, Social Security, or Medicare.gov. We take no payment from any carrier to feature a plan.
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Frequently asked questions
Does Medicare cover dialysis?
Yes. Medicare covers both in-center hemodialysis and home dialysis for people with end-stage renal disease (ESRD), regardless of age — you don't have to be 65 to qualify. Original Medicare Part B pays 80% of the Medicare-approved amount for dialysis treatments and related services, after your Part B deductible ($283 in 2026). You're responsible for the remaining 20% coinsurance, which has no annual ceiling under Original Medicare unless you have a Medigap policy or switch to a Medicare Advantage plan with a capped out-of-pocket maximum. Source: Medicare.gov's ESRD coverage page.
How soon does Medicare start paying for dialysis?
For most people who start in-center dialysis, Medicare coverage begins the first day of the fourth month of treatment — a 3-month gap most patients don't expect. There's a faster path: if you complete training for home dialysis at a Medicare-certified facility and are expected to finish training and self-administer your own treatments, coverage can start as early as your very first month of dialysis. Ask your care team about home dialysis training specifically if the 3-month wait is a financial concern.
What is the Medicare 30-month coordination period?
It's a 30-month window that starts the first month you become eligible for Medicare because of kidney failure — even if you haven't actually enrolled in Medicare yet. If you have coverage through an employer group health plan during that window, federal rule requires the employer plan to pay first and Medicare to pay second, no matter how large or small the employer is. After 30 months, Medicare switches to primary payer. Many people still choose to enroll in Medicare during the coordination period anyway, because Medicare can help cover the deductibles, copays, and coinsurance your employer plan leaves behind. Source: Medicare.gov.
Can someone with kidney failure join a Medicare Advantage plan?
Yes, since January 1, 2021. Before that date, the 21st Century Cures Act's ESRD provision barred most people with ESRD from Medicare Advantage; they were funneled into Original Medicare with few exceptions. Since the rule changed, ESRD Medicare beneficiaries can choose either Original Medicare or a Medicare Advantage plan, the same as anyone else on Medicare. The real-world effect was fast: a peer-reviewed study using CMS's own enrollment data found Medicare Advantage enrollment among ESRD beneficiaries rose from 24.8% in December 2020 to 43.1% in December 2022. Confirm any plan's network includes your specific dialysis center before you enroll — coverage of "dialysis" in general doesn't guarantee your clinic is in-network.
How much does dialysis cost with Medicare in 2026?
Medicare pays dialysis facilities a bundled rate CMS sets each year — $281.71 per treatment for calendar year 2026. You owe 20% coinsurance on the Medicare-approved amount for your care, which for a standard 3-times-a-week hemodialysis schedule works out to roughly $8,789.35 a year in coinsurance alone, before any other Part B costs — and that has no annual ceiling under Original Medicare. A Medigap policy or a Medicare Advantage plan's built-in out-of-pocket maximum are the two ways to cap that exposure. This is an illustrative calculation built from CMS's published 2026 base rate and a standard treatment schedule, not a separately published CMS total — your actual bill depends on your specific facility, treatments, and any other care you receive.
Does Medicare cover a kidney transplant?
Yes. Medicare covers kidney transplant surgery, the transplant hospital stay, and immunosuppressant drugs needed afterward, as long as the transplant happens at a Medicare-approved facility. Coverage under ESRD rules typically starts the month you're admitted for the transplant, or up to 2 months before if the surgery is delayed past that point. One detail worth knowing: since a 2021 rule change, Medicare Advantage plans are no longer responsible for kidney organ acquisition costs — those are covered under Original Medicare's fee-for-service program instead, even if you're enrolled in a Medicare Advantage plan for everything else.
Can I get a Medigap policy in South Dakota if I'm under 65 with kidney failure?
Yes — and this is a real advantage South Dakota residents have that federal law doesn't guarantee everywhere. According to the South Dakota Division of Insurance, beneficiaries under 65 who qualify for Medicare by reason of disability get a 6-month Medigap open enrollment period beginning the date they enroll in Part B, during which a Medigap policy can be obtained regardless of health condition — the same protection South Dakotans get when they turn 65. That window is easy to miss if nobody tells you it exists, and once it closes, insurers can medically underwrite you and decline coverage.
When does Medicare coverage based on ESRD end?
Medicare coverage based on ESRD ends 12 months after you stop dialysis, or 36 months after a successful kidney transplant. If dialysis restarts within 12 months, or a new transplant happens within 36 months of the last one, ESRD-based Medicare coverage resumes and the 30-month coordination period rules can restart too. If you have other Medicare eligibility — because you're 65 or already receiving Social Security disability benefits for a separate reason — your coverage continues on that basis instead.