The 1972 amendments to the Social Security Act extended hospital insurance (HI) and
supplementary medical insurance (SMI) protection, effective July 1, 1973, to the Social
Security Administration (SSA) and Railroad Retirement Board (RRB) beneficiaries whose
kidney failure progressed to the point that they have ESRD and require dialysis (including
peritoneal dialysis) or a kidney transplant. Entitlement to HI and SMI based on ESRD
extends only to the claimant who has ESRD, not to other members of the family. The
amendments protect the beneficiary for all services covered by Medicare, not only
those related to kidney disease.
Effective October 1, 1978, amendments to title II and title XVIII of the Social Security
Act significantly modified the ESRD provisions of the Medicare program. These provisions:
encouraged self-dialysis and transplant surgery;
removed the age restriction (prior to the 1978 amendments, the claimant had to be
under age 65);
waived the three month qualifying period for those who participated in self-dialysis;
extended coverage for early transplant by two months prior to transplant surgery;
changed post-transplant Medicare coverage from 12 months to 36 months following a
In addition, the Tax Equity and Fiscal Responsibility Act of 1982 extended coverage
to Federal employees with ESRD effective on January 1, 1983.
NOTE: To distinguish between HI and SMI based on ESRD and HI and SMI based on other eligibility
requirements, we refer to HI and SMI based on renal failure as R-HI and R-SMI respectively.