If you’re facing kidney failure, learn these insurance basics to help pay for your care and treatment.
People with kidney failure, also known as end-stage kidney disease (ESKD), can face significant insurance challenges, such as high costs for dialysis and potential difficulties qualifying for comprehensive coverage due to the pre-existing condition. Since policies and coverage details can change and new plans become available, itt’s important to review your insurance options annually to ensure that your coverage evolves along with your personal health needs. Learn more about insurance options for people living with kidney failure.*
Most people with chronic kidney disease (CKD) apply for Medicare when they are ready to start dialysis or undergo a kidney transplant. Medicare is best known as health insurance for people over 65 years old, but an exception is made for people who have ESKD.
Medicare pays 80% of the cost of dialysis treatment and 80% of the cost of immunosuppressant medications after transplant.
It’s only been within the last year or so that people with chronic kidney disease (CKD) have been able to enroll in Medicare Advantage (MA) plans, which are offered by a private company that contracts with Medicare.
MA insurance plans:
Your insurance needs and options can change as your health does.
If you qualify for Medicare, your employer group health plan insurance (EGHP) will be your primary insurance (first payer) for 30 months (coordination period) after you start dialysis or have a kidney transplant.
Once you have Medicare, you no longer qualify for insurance through the Affordable Care Act.
Since Medicare covers 80% of dialysis costs and 80% of the immunosuppressant drug costs, supplemental insurance can be helpful for covering the remaining 20%. These are called Medigap plans.
Medigap plans are available for anyone over the age of 65, and some states offer them for younger people, as well. To obtain these plans, you need to apply within six months of becoming eligible for Medicare.
Medicaid is based on your need, determined by your income, and requirements vary from state to state. It usually covers most dialysis and transplant costs.
Some states offer managed care plans for people who qualify for both Medicare and Medicaid.
*National Kidney Foundation. (n.d.) Insurance Options for Kidney Patients. Retrieved from https://www.kidney.org/atoz/content/insurance
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