What Insurance Covers Dialysis?

There are many health insurance packages on the market, but you want to research which types offer the best services for chronic kidney disease patients (CKD), dialysis treatment, kidney transplant, and the cost of immunosuppressant medications for post-treatment.

Choosing the right insurance option for chronic kidney disease patients may feel overwhelming. Decisions can become increasingly complicated because insurance options change as kidney disease progresses.

Whatever the case, you will need the right information in your decision-making process. When undergoing treatment, you can talk to your kidney center for help. 

What is Chronic Kidney Disease?

CKD occurs when over a period of time, kidneys lose their ability to function property. Your kidneys have the job of filtering blood. They remove extra fluid and waste and flush them from your body as urine.

When there’s a failure in the system, waste builds up in your blood. When kidney failure is chronic, it may occur for years before symptoms begin to show, and the condition will continue to progress.

There are several treatments doctors use to address CKD. Dialysis is a treatment that uses a machine to filter your blood to remove the extra fluid and waste. Kidney transplant is a surgery that replaces the diseased kidney with a new healthy kidney from a donor.

Those who undergo kidney transplants need to take immunosuppressant medications after surgery to ensure that the donated kidney is accepted within the body.

Insurance Coverage Available for Treatment

The cost of CKD treatment is expensive. Quality health insurance coverage offers relief in assisting patients and their families to pay for medical treatments. Insurance coverage can come in many forms, including commercial coverage and government-sponsored coverage. Both types make it possible to address cost concerns you may have.

Under commercial coverage, one resource is the Employer Group Health Plan (EGHP), which is offered through your or your spouse’s employment. The amount and type of coverage will depend on the insurance plan that the employer has contracted with. 

In the case of job loss, the insurance coverage through EGHP option is lost. That is where COBRA (Consolidated Omnibus Budget Reconciliation Act) plans come in, which can pick up coverage for a number of months after the initial loss. The downside, however, is it can be used only for a specific period of time after employment health insurance expires.

Individual health plan coverage is direct coverage through an insurance company or medical network. It includes the same coverage offered through employers, but is paid independently by the policy-holder.

Another commercial insurance package to consider is the Affordable Care Act (ACA), sometimes known as “Obamacare.” These options are Qualified Health Plans (QHPs) that meet the law-required basic vital benefits for care.

Government-sponsored insurance plans include Medicaid. The requirements for eligibility are based on financial needs, and the specifics for qualification differ from state to state. Medicaid supplemental plans provide additional coverage for costs not covered by Medicaid, and include Medigap, which is sold by private insurance companies.

Medicare is typically reserved for those who are 65 or older. With certain condition diagnoses, such as with End-Stage Renal Disease, younger patients may qualify for Medicare. There are 4 main types of Medicare, labeled A, B, C, and D. Each offer different coverage and may be suitable for different types of patients. 

Two state-sponsored programs, State kidney programs and State high-risk insurance pools, are particularly relevant to CKD patients. State kidney programs are offered in many states, and they provide assistance specifically for kidney disease patients. State high-risk insurance pools are for those who may not qualify for marketplace insurance, especially when due to a pre-existing health condition, such as CKD.

Additional government-sponsored insurance options are available for families with specific qualifications. These include programs for government employees and their families, provided through federal or state employee coverage.

US military service members and their families are eligible for programs such as TRICARE and VA. The Indian Health Service is a federal health program that provides access for American Indians and Alaska Natives. 

Coping With the Barriers to Accessing Healthcare

Quick health insurance access for patients with CKD at the onset of the disease is an important intervention. Difficulty getting proper medical care, transportation to appointments, finding the right type of physician, and inability to pay for medical services and treatments all create barriers to patients receiving proper care. Recognizing potential barriers to healthcare access is important to know what concerns to address in seeking coverage.

Putting the Patient First

Talking to your insurance coordinator and healthcare provider is important to address your needs and understand your coverage options. These qualified specialists want to help you make informed decisions that are in your best interest.

The variety of health insurance plans, each with differing qualifications, services covered, and premium and copayment amounts, make evaluating options difficult. By researching your options and bringing specific questions to your insurance coordinator and healthcare providers, you can get help to identify the right insurance choices for you and your family.