Let me be direct with you, because that's what I'd be if you were sitting in my office at Mt. Zion. The kidney disease crisis among Black seniors in Prince George's County, Maryland is not an accident. It is the compounded consequence of decades of inequity — in healthcare access, in food environments, in the chronic stress of structural racism — landing on bodies that have carried more than their share of weight for a very long time.
Prince George's County is a majority-Black county — 65.6% of its approximately 967,000 residents identify as Black or African American, according to the U.S. Census Bureau's 2023 American Community Survey. This is one of the wealthiest majority-Black counties in the nation by median household income. But wealth at the county level does not protect individual Black seniors from a healthcare system that was not built for them.
The two primary drivers of ESRD are uncontrolled diabetes and uncontrolled hypertension — and Black Americans carry disproportionate burdens of both. The CDC PLACES data for the broader Maryland region shows that communities with significant Black populations face diagnosed diabetes rates consistently above 12-15% among adults. Hypertension rates in Prince George's County have been documented at 41.2% in prior PLACES reporting cycles — a number I've covered before on this desk in the context of blood pressure alone.
But here's what the hypertension articles don't fully capture: when high blood pressure goes uncontrolled for years — which happens more often in communities with limited access to primary care, in communities where people are working two jobs and skipping appointments, in communities where the nearest pharmacy is 4 miles away — the kidneys take the hit. Chronically elevated blood pressure literally scars kidney tissue. Over years, that scarring becomes irreversible. That's ESRD.
For seniors who came onto Medicare through disability — not age — the story is often even harder. They were sick younger. They had ESRD or its precursors decades before they turned 65. And they navigated a Medicare system that, until very recently, treated ESRD patients as a separate, limited class of beneficiaries with fewer plan options than everyone else.
Here is what Medicare covers for ESRD, and I want you to hold onto every single number:
Now here is the game-changing update that too few Black seniors on disability in Prince George's County know about:
Before January 1, 2021, if you had ESRD, you could NOT enroll in a Medicare Advantage plan. Period. You were locked into Original Medicare (Parts A and B). That meant no extra benefits, no reduced cost-sharing, no dental, no vision, no transportation — nothing that Medicare Advantage plans offer. The 21st Century Cures Act changed that rule. As of 2021, people with ESRD can enroll in Medicare Advantage plans — including Dual-Eligible Special Needs Plans (D-SNPs) — during designated enrollment windows.
In 2026, Prince George's County has 47 total Medicare Advantage plans available, according to CMS Medicare Plan Finder data. Of those, a subset are D-SNPs that coordinate Medicare and Medicaid benefits — and for a dual-eligible senior on dialysis, a D-SNP can mean the difference between financial survival and medical bankruptcy.
Pastor Gloria sends free alerts — plan changes, enrollment windows, benefit cuts — directly to your inbox. No spam. Just the truth, on time.
I want to be clear: I am not recommending any plan. My job is to give you the framework so you can ask the right questions. What I can tell you is how to evaluate these 47 plans through the lens of kidney disease and dialysis.
According to CMS Medicare Plan Finder data for Prince George's County (FIPS: 24033) in 2026, the county has a diverse plan landscape that includes HMO, PPO, and Special Needs Plans across multiple carriers. When you are on dialysis, the following criteria are non-negotiable in evaluating any plan:
This is where righteous fire is warranted. The Medicare Savings Program (MSP) is not charity. It is not a handout. It is a federally mandated program that uses Medicaid dollars to pay Medicare cost-sharing for low-income beneficiaries. There are four levels:
Here is the heartbreak: according to analysis by the Medicare Payment Advisory Commission (MedPAC) and state SHIP data, an estimated 45% of eligible Black seniors in Maryland who qualify for at least the SLMB level of the Medicare Savings Program are NOT enrolled. That means they are paying $185 per month — $2,220 per year — for their Part B premium when they legally qualify to have Maryland Medicaid pay it for them.
For a senior on disability income — often receiving $1,200 to $1,800 per month from Social Security Disability Insurance — that $2,220 per year is not abstract. That is groceries for two months. That is whether the electricity stays on in July. That is whether you can afford your blood pressure medication at the same time as your dialysis-related prescriptions.
Why don't they enroll? The reasons are structural, not personal. The application process requires navigating Maryland Medicaid — a different agency with a different form, a different phone number, and a different set of documentation requirements. Nobody hands you a brochure at the Social Security office. Your doctor doesn't know to tell you. And in a community that has historically been burned by government programs that promised help and delivered harm — yes, Tuskegee is relevant here, Tuskegee ended in 1972 and there are people sitting in my congregation right now who were alive for that — skepticism is not ignorance. It is wisdom earned the hard way.
But the Medicare Savings Program is money that is yours. Not charity. Money that was legislated for you. And I am not going to let distrust or paperwork keep you from it.
If you are newly diagnosed with ESRD and starting dialysis, your Medicare enrollment timing is different from the standard rules. Here is exactly how it works:
If you are not yet on Medicare: ESRD qualifies you for Medicare regardless of age. You can enroll in Medicare Part A and Part B. Your coverage typically begins the first day of the fourth month of regular dialysis treatments — unless you train for home dialysis, in which case coverage can begin earlier.
The Medicare Advantage Special Enrollment Period for ESRD (post-2021): Once you are eligible for Medicare due to ESRD, you have a Special Enrollment Period to enroll in a Medicare Advantage plan. This window is typically available:
Before 2021, none of that mattered — ESRD patients couldn't enroll in MA plans at all. Now they can. And in Prince George's County, with 47 plans available in 2026, ESRD patients have real choices they never had before. The question is whether they know it.
Prince George's County is home to multiple dialysis facilities operated by major national chains — DaVita and Fresenius Kidney Care both operate locations in the county, with centers in areas including Hyattsville, Largo, and Capitol Heights. The geographic distribution of dialysis centers matters enormously: for a senior on disability who cannot drive and depends on Medicaid transportation or family members, a facility 3 miles away versus 12 miles away can determine whether they get to treatment 3 times a week or skip sessions — and skipping dialysis is life-threatening.
Prince George's County is also served by Federally Qualified Health Centers (FQHCs) — federally funded clinics that serve patients regardless of ability to pay, using a sliding-fee scale. Key FQHC providers in the county include:
These resources matter because the pathway to preventing ESRD — and the pathway to managing it once you have it — runs through primary care. A good primary care doctor who monitors your creatinine levels, manages your blood pressure, adjusts your diabetes medication, and refers you to a nephrologist at the right time can slow kidney disease for years. Years that matter. Years that might mean the difference between manageable kidney disease and dialysis three times a week for the rest of your life.
The tragedy is that in Prince George's County, primary care access has been uneven — particularly for Black seniors on Medicaid or disability Medicare, whose insurance many private practices do not accept at all. That is a systemic failure, and it is written into the ESRD statistics we are discussing today.
A senior on dialysis typically manages a complex medication regimen: phosphate binders, blood pressure medications, erythropoiesis-stimulating agents, vitamin D analogs, anticoagulants, and often diabetes medications as well. Even with Medicare Part D coverage, the out-of-pocket costs can be staggering — or they were, before recent changes.
The Inflation Reduction Act of 2022 created a $2,000 annual out-of-pocket cap for Medicare Part D drug costs, effective January 1, 2025. This is the most significant Medicare drug coverage improvement in a generation, and it matters most for people with complex, expensive medication regimens — which describes almost every dialysis patient.
But there's more. Low Income Subsidy (LIS) / "Extra Help" is a federal program that helps Medicare beneficiaries with limited income pay for Part D premiums, deductibles, and copays. In 2026:
Again — I want to emphasize that these are benefits you are owed, not favors you are being granted. The application exists because Congress recognized that people cannot choose between dialysis and groceries in the richest nation on earth. That recognition only becomes real when you actually apply.