Responsum for CKD

{{user.displayName ? user.displayName : user.userName}}
{{ user.userType }}
Welcome to

Responsum for CKD

Already a member?

Sign in   
Do you or someone you know have CKD?

Become part of the foremost online community!

Sign Up Now

Or, download the Responsum for CKD app on your phone

National Kidney Foundation

National Kidney Foundation

Insurance Basics for People With ESKD

Insurance Basics for People With ESKD

If you’re facing kidney failure, learn these insurance basics to help pay for your care and treatment.


Published on {{articlecontent.article.datePublished | formatDate:"MM/dd/yyyy":"UTC"}}
Last reviewed on {{articlecontent.article.lastReviewedDate | formatDate:"MM/dd/yyyy":"UTC"}}

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.*

Medicare Basics for Dialysis and Transplants

Medicare

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.

Medicare Advantage

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:

  • Provide all Medicare Part A and Part B benefits 
  • Have strict network coverage areas
  • Sometimes require co-pays for clinic visits
  • May provide additional coverages for dental visits and/or prescription drugs

Options as Your CKD Progresses

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. 

  • After the first 30 months, Medicare will become your primary insurance. 
  • You’re not obligated to apply for Medicare at any time. If you choose to apply:
    • Keep in mind that if your private insurance is through the Affordable Care Act, you’ll lose that coverage.
    • You can apply when you first start dialysis or wait until the 30-month coordination period is almost over.
    • You will need to apply for Medicare parts A and B when you become eligible, if you’re planning on having a transplant and want Medicare to pay for at least part of your immunosuppressant drugs.

Once you have Medicare, you no longer qualify for insurance through the Affordable Care Act.

Supplemental Plans

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 

Responsum Health closely vets all sources to ensure that we always provide you with high-quality, reliable information. We do not, however, endorse or recommend any specific providers, treatments, or products, and the use of a given source does not imply an endorsement of any provider, treatment, medication, or procedure discussed within.

Source: {{articlecontent.article.sourceName}}

 

Join the CKD Community

Receive daily updated expert-reviewed article summaries. Everything you need to know from discoveries, treatments, and living tips!

Already a Responsum member?

Available for Apple iOS and Android