Insurance

Since chronic kidney disease requires ongoing treatment you might be concerned about how you will afford the expense.  Please keep in mind that there are many options that may help you pay for your dialysis treatments. Some of those options included Medicare, Medicaid, Commercial insurance, Veterans benefits, and various renal programs.

 

Medicare

 In 1972 legislation was passed which provided health insurance coverage for persons age 65 and older, persons under age 65 with certain disabilities and persons of any age with end-stage renal disease.  To qualify for Medicare a person must have paid into the program out of wages earned and have worked a minimum of 10 quarters with 5 of those quarters within the last 5 years.  If you do not qualify for Medicare because you do not have enough work credits, you may qualify thru a spouse or former spouse or thru your parent if you are under age 26.  It is important to remember that Medicare has a deductible and pays 80% of the allowable charges, you will need secondary or supplemental insurance to cover the deductible and the remaining 20% of allowable charges.


Medicare Part A

Covers kidney transplants, inpatient care while in the hospital, inpatient care in skilled nursing facilities, hospice, and some home health care.  Most people don’t have to pay a monthly premium because either they or their spouse paid Medicare taxes while they were working.


Medicare Part B

Covers doctors’ services, outpatient hospital care, dialysis, laboratories, other medical services that Part A doesn’t cover, and other items such as transplant medications when they are medically necessary.  Everyone must pay a monthly premium which can change yearly.
**If you are eligible for Medicare only because of permanent kidney failure, your eligibility usually can’t start until the fourth month of dialysis unless you choose a method of Home Therapy and then Medicare coverage begins immediately. 


Medicare Part D

You may or may not decide to enroll in Part D which offers some prescription drug coverage.  You must have Medicare Part A in order to enroll in Medicare Part D. If you have current insurance coverage for prescriptions, you may not need Medicare Part D.

Medicare Advantage Plans

Medicare Advantage Plans or Medicare Replacement Plans replace original/traditional Medicare and combine Medicare Parts A, B and typically offer Part C prescription drug coverage.  Medicare Advantage Plans also include other services that original Medicare does not provide. If you are interested in one of these plans it is important to find out what the dialysis benefit is and what your out of pocket expense will be for dialysis treatment.

Medicare Supplement Plans

Supplemental insurance is purchased specifically to “supplement” Medicare, Medicare supplement your Medicare benefit.  There are many options on the market available to purchase, these plans pay for your Medicare deductible and the 20% co-insurance left after Medicare pays their portion.  You can choose a plan that covers all of your out of pocket leftover from Medicare or a portion of your out of pocket depending on how much you want to spend monthly on your premium.


Medicaid

is a joint federal and state program that helps pay medical costs for some people with limited income and resources.  Most health care costs are covered if you qualify for both Medicare and Medicaid. You must fill out a Department of Social and Health Services (DSHS) application and provide supporting documentation.

Veterans Benefits

If you are a veteran, the U.S. Department of Veterans Affairs can help pay for dialysis treatments. 

Commercial Insurance

Most commercial insurance policies obtained through employment, as a retirement benefit, or purchased individually will coordinate with your Medicare coverage to minimize your out of pocket expense.  It is very important to remember that dialysis has some unique coverage issues and if you are shopping for or changing your commercial insurance plan you will need to inquire specifically what your dialysis coverage will be on the new plan.