Medicare Open Enrollment with kidney disease: what to check before December 7

Every fall, Medicare gives you a few weeks to look over your coverage for next year. If you have kidney disease, the most important question is not the premium. It is whether your kidney care team is still covered.

A short look at the calm, one-page review that helps kidney patients compare Medicare plans for next year.

Welcome to the October issue of Kidney Health Monthly. Last month we sat down at the kitchen table to write a dialysis emergency plan. This month we are back at the same table, with a different stack of paper: the envelopes from Medicare and your health plan that start arriving every fall.

Medicare Open Enrollment runs from October 15 to December 7, 2026. During those weeks, anyone with Medicare can change their health or drug coverage for next year, and the changes take effect on January 1, 2027. For most people it is a chore. For people with kidney disease, dialysis, or a kidney transplant, it is one of the few times each year when a few phone calls can protect the care you already depend on.

A quick word before we start: this article is general information, not insurance or legal advice. We are your kidney doctors, not your insurance agents. Our goal is to help you ask the right questions, and to point you toward free, unbiased people who can help you answer them.

An insurance counselor at a community center desk helping an older adult compare two health plan brochures side by side, both smiling, with a notepad and pen on the table

The short version

If you remember only three things from this article, make them these:

Check your care team before you check the price. Make sure your nephrologist, dialysis unit, and transplant center are in the plan’s network.
Know the new numbers. Medicare drug coverage has a yearly cap on what you pay out of pocket, and it goes up from $2,100 in 2026 to $2,400 in 2027.
Get free help. GeorgiaCares counselors are free, unbiased, and do not sell insurance.

What Open Enrollment is, in one paragraph

Each fall, your plan sends an Annual Notice of Change that explains how your costs and benefits will change next year. Between October 15 and December 7 you can join, switch, or drop a Medicare Advantage plan, move between Original Medicare and Medicare Advantage, or join, switch, or drop a Medicare drug plan. If you look things over and are happy with what you have, you do not need to do anything; your coverage continues automatically. If you do switch, the new plan must receive your request by December 7.

If you are already in a Medicare Advantage plan and change your mind after January 1, there is a second window from January 1 to March 31 when you can make one change. It is a useful safety net, but it is far easier to get it right in the fall.

Medicare Advantage and kidney failure: a bigger choice than it used to be

For many years, most people with kidney failure (also called end-stage renal disease, or ESRD) could not join a Medicare Advantage plan. That changed in January 2021, when the 21st Century Cures Act allowed people with ESRD to enroll in Medicare Advantage plans. Medicare’s own guide now says it plainly: people with ESRD can choose either Original Medicare or a Medicare Advantage plan.

Many patients have made that switch. A large national study in JAMA Network Open found that the share of Medicare beneficiaries with ESRD enrolled in Medicare Advantage rose from about 25 percent in January 2020 to about 43 percent by December 2022.

There are real reasons people choose these plans. A 2026 review in the American Journal of Kidney Diseases notes that Medicare Advantage plans offer a yearly cap on out-of-pocket spending and some extra services that Original Medicare does not cover, and some plans focus on care coordination. The same review lists the concerns kidney doctors watch for: limited provider networks, prior authorization hurdles (when the plan must approve a test, drug, or service before it pays), and differences in access to medications and transplants.

None of that makes Medicare Advantage good or bad for you. It means the details of the specific plan matter more for a kidney patient than for almost anyone else.

The network check: the most important ten minutes of Open Enrollment

Medicare Advantage plans usually require you to use doctors and facilities in their network. Medicare’s kidney booklet advises checking with your providers and with the plan before you join, to make sure your providers are in the plan’s network.

This matters because dialysis networks are not all the same. A study in Health Affairs looked at dialysis facilities in 2021 and found that, on average, a facility contracted with only about 60 percent of the Medicare Advantage plans offered in its area. In other words, your dialysis unit may be in some local plans and not in others.

Before you pick a plan for 2027, confirm each of these is in network:

Your nephrologist (and, if you are a KHC patient, our practice).
Your dialysis unit, or your home dialysis program if you dialyze at home.
Your transplant center, if you are on a waitlist, being evaluated, or already have a transplant. Medicare covers a kidney transplant only at a hospital that is Medicare-certified to do kidney transplants, and a plan may have its own list of approved centers.
Your pharmacy, and every medicine you take, on the plan’s drug list.
The hospital you would want to go to if you needed to be admitted.

The most reliable way to check is to call the plan and ask directly, then call the office or unit and ask whether they accept that plan for 2027. Write down the name of the person you spoke with and the date.

Doctor’s tip: ask the plan specifically how its prior authorization works for the things you use most, such as dialysis-related medicines, transplant medicines, or imaging. A plan that looks cheaper on paper can cost you time and stress if routine kidney care needs repeated approvals.

Prescription costs: the 2027 out-of-pocket cap

Kidney patients often take many medicines, so the Part D numbers are worth knowing. Under the Inflation Reduction Act, Medicare drug coverage now has a yearly cap on out-of-pocket costs for covered drugs.

According to CMS’s final 2027 payment announcement, for the standard Part D benefit:

The out-of-pocket cap is $2,100 in 2026 and rises to $2,400 in 2027.
The standard deductible is $615 in 2026 and rises to $700 in 2027.

Your own plan may have a lower deductible, and the cap counts only covered drugs on your plan’s list, which is one more reason to check your medicines against the drug list before you choose.

If big pharmacy bills early in the year are hard on your budget, ask your plan about the Medicare Prescription Payment Plan. Every Medicare drug plan must offer it. It lets you pay your out-of-pocket drug costs in monthly installments across the calendar year instead of all at once at the pharmacy. Medicare is clear that it does not lower your total drug costs; it spreads them out. It is voluntary, there is no charge to participate, and you sign up by contacting your plan.

If your income is limited, you may also qualify for Extra Help with Part D costs or for a Medicare Savings Program that helps with premiums. A GeorgiaCares counselor can tell you whether you might qualify.

An older man at home on a phone call, holding a checklist and a pill organizer, with his dialysis appointment calendar on the wall behind him in calm autumn light

Transplant recipients: the 36-month question and Part B-ID

If you have Medicare only because of kidney failure, Medicare’s kidney booklet explains that your coverage ends 36 months after the month of your kidney transplant (or 12 months after you stop dialysis). During those first 36 months, Part B helps pay for your transplant medicines (immunosuppressive drugs) if your transplant was done at a Medicare-certified hospital and you had Part A at the time.

The problem has always been what comes after month 36. Transplant medicines have to be taken for as long as the kidney works, and a transplant pharmacy review noted that skipped doses because of cost were a frequent problem once that three-year coverage ended.

That is why the Medicare Part B immunosuppressive drug benefit (Part B-ID) exists. According to CMS and Medicare.gov:

It is for people whose Medicare because of ESRD ends 36 months after a kidney transplant and who do not have certain other health coverage for these drugs.
It covers only your immunosuppressive drugs, not doctor visits, hospital care, or other medicines. It is not a substitute for full health coverage.
The monthly premium is $121.60 in 2026 (higher for some incomes), and the Part B deductible and 20 percent coinsurance apply.
You sign up by calling Social Security at 1-877-465-0355 (TTY 1-800-325-0788), a phone line set up just for this benefit.

If you are approaching your 36-month mark, please tell your transplant team and your KHC nephrologist. We would much rather plan this with you a few months early than hear about a gap in your medicines after it happens.

Medigap in Georgia if you are under 65

Medicare Supplement Insurance (Medigap) helps pay some of the costs Original Medicare leaves behind, such as the 20 percent coinsurance on dialysis. For people under 65, the rules are tricky.

Under federal law, Medigap insurers generally do not have to sell policies to people under 65. Each state can add its own protections. Georgia law (O.C.G.A. § 33-43-3) says that insurers who sell Medigap to people 65 and older in Georgia must also offer Medigap to people enrolled in Medicare because of disability or ESRD, and it describes a window of six months after you enroll in Part B to apply. What it does not tell you on its own is which plans will be available to you, at what price, or what happens if you miss that window.

So our honest advice here is: ask before you act. Call GeorgiaCares or the Georgia Office of Commissioner of Insurance and Safety Fire before you rely on Medigap, and especially before you drop one.

One more caution, straight from Medicare: if you already have Medigap and join a Medicare Advantage plan, you might decide to drop your Medigap policy, and you may not be able to get the same Medigap policy back later, depending on your state’s rules and your situation. For a kidney patient, that is a decision worth slowing down for.

Free, unbiased help: GeorgiaCares

Every state has a State Health Insurance Assistance Program (SHIP). In Georgia it is run by the Department of Human Services, Division of Aging Services, and often goes by GeorgiaCares (Georgia SHIP).

Their counselors are free, give unbiased information, are not affiliated with any insurance company, and do not sell insurance. They can help you understand your plan choices, enroll, sort out bills and claims, file appeals, and apply for help paying costs.

GeorgiaCares: call 1-866-552-4464 and choose option 4, Monday through Friday, 8 a.m. to 5 p.m.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, is available 24 hours a day.
Medicare.gov/plan-compare lets you compare plans side by side, check your drugs, and search for your doctors.

Around Open Enrollment you will also get a lot of mail and calls from companies selling Medicare plans. Medicare reminds people that Medicare.gov, the “Medicare & You” handbook, and 1-800-MEDICARE are its official sources of unbiased information.

From our physicians

We chose Medicare for October because it is the one season of the year when an insurance decision can quietly change who takes care of you. It is easy to picture: a patient switches plans in November for a lower premium or a dental benefit, and in January learns that the dialysis unit down the road, the one where the nurses know their name, is no longer in network.

We are not here to tell you which plan to choose. We do not sell insurance, and the right answer depends on your health, your budget, and your family. What we can tell you is what matters most from the kidney side of the table: keep your kidney care team together, keep your medicines covered, and do not drop coverage you might not be able to get back.

So here is what we are asking this month. Open your Annual Notice of Change before October 15. Make a short list of your doctors, your dialysis unit, your transplant center, your pharmacy, and your medicines. Then make a few calls, or sit down with a GeorgiaCares counselor, before December 7. If you are a transplant patient getting close to your 36-month mark, add one more call: to Social Security about Part B-ID.

And if you are unsure whether a plan covers KHC, call our office. We are always glad to answer that question.

Patient resources

Read your Annual Notice of Change from your current plan; it explains what is changing for 2027.
Call GeorgiaCares at 1-866-552-4464, option 4, for free, unbiased help comparing plans.
Use Medicare.gov/plan-compare to check that your drugs, pharmacy, and doctors are covered.
Transplant recipients: ask your transplant team about your 36-month date, and call Social Security at 1-877-465-0355 about Part B-ID if you will not have other coverage.
Newer to kidney care? Start with do I need a nephrologist and the stages of kidney disease.
Thinking ahead about dialysis? When do I need dialysis explains how that decision is made.

Let’s keep your care team together

If you have questions about how a plan change could affect your kidney care, your medicines, or your transplant follow-up, bring them to your KHC nephrologist. Book an appointment and we will go through the kidney side of your list with you, well before December 7.

This article is for general education and is not a substitute for personalized medical advice. Talk with your doctor or nephrologist about your specific situation.