Medicare Part B Immunosuppressive Drug Benefit

Beginning January 1, 2023, qualifying individuals whose entitlement to Medicare based on End Stage Renal Disease (ESRD) ended the 36th month after the month in which the individual received a successful kidney transplant, may be eligible for the Medicare Part B Immunosuppressive Drug benefit. This is a new Medicare benefit which provides coverage for immunosuppressive drugs only.

Eligibility Requirements

Individuals Eligible for the Medicare Part B Immunosuppressive Drug Benefit:

• Are or were entitled to Medicare based on ESRD that ended the 36 month after the month of a successful kidney transplant; and
• Attest that they are not enrolled in other health care coverage that would make them ineligible to receive this benefit.*

*Note: Examples of other health-care coverage that makes an individual ineligible for the Medicare Part B Immunosuppressive Drug benefit include:

• Employer or Individual Health Plans
• Health Insurance Marketplace plans defined in section 2791 of the Public Health Service Act
• TRICARE for Life
• Being enrolled in the patient enrollment system of the Department of Veterans Affairs (VA) or otherwise eligible to receive immunosuppressive drugs from the VA
• Medicaid or the State Children’s Health Insurance Program (CHIP) coverage that includes immunosuppressive drugs

Enrollment Process

Eligible individuals can enroll in the Medicare Part B Immunosuppressive Drug benefit by contacting the Social Security Administration at 1-877-465-0355 or by downloading and filling out the form CMS-10798. 

The completed form should be mailed to:

Social Security Administration
Office of Central Operations
PO Box 32914
Baltimore, Maryland 21298-2703

Enrollment Periods and When Coverage Begins

Eligible individuals can enroll beginning October 2022. For those that enroll by December 31, 2022, coverage will begin January 1, 2023. For those that enroll after December 31, 2022, coverage will begin enrollment will begin the month following the month that they enroll.

Eligible individuals can enroll at any time, and individuals who terminate their coverage can re-enroll at any time.