Health Insurance for Kidney Patients: Steps to Pick Your Plan

Updated: November 9, 2022
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Getting health insurance for kidney patients is quite a confusing decision to take ever. Most life insurance firms will not write policies for persons with pre-existing medical issues, such as a urinary organ. However, some insurers will continue to provide coverage if you fulfill specific criteria. This blog on newhealthinsurance.com will explain how to purchase life insurance if you have kidney problems. We will also discuss the many types of plans available to you and the considerations that insurers evaluate when offering insurance to persons with health conditions. Let’s jump to the point.

Health Insurance for Kidney Patients: Things to Consider 

Transplant options When thinking about getting a transplant:
  • Verify that the plans you consider include transplant services and that the provider network includes your chosen transplant center.
  • As they vary by plan, be sure to account for out-of-pocket expenses or your costs for transplant-related services not covered by insurance.

If you want to change your insurance, let your transplant facility know right away.

Dialysis benefits Make sure that dialysis is a benefit offered by the plans you are considering.
Provider network and access Review the plan’s provider network to ensure your favorite providers are covered. This covers the services you require from your primary care physician, nephrologist, and any additional providers.
Prescription benefits Make sure to study the prescription benefits and medication list for each plan as not all cover the same medications.
Family vs. individual coverage Plans that offer more than individual coverage should be considered if you wish to insure family members and yourself.
Other benefits If you value benefits like vision insurance or dental coverage, keep them in mind while comparing plans.
Out-of-pocket costs When reviewing plan alternatives, it’s crucial to consider all out-of-pocket expenses, including coinsurance, deductible, premium, and copays.

Health Insurance for Existing Dialysis Patients

Patients on dialysis typically pays $474 per month for life insurance rates. Dialysis patients are not eligible for regular whole life insurance or term life insurance. Finding a life insurance firm for dialysis patients that will sell you last-expense or no-exam comprehensive medical insurance will also be problematic. 

Guaranteed issue whole life insurance is your best and frequently only option for life insurance. Unfortunately, this sort of coverage has the most expensive premiums and frequently has a small death benefit. The rates for a guaranteed issue whole policy with a $100,000 death benefit are broken down by gender and age.

What Is Kidney Disease?

Urinary organ disease, or CKD, impairs the ability of the kidneys to filter blood properly. Due to this, extra fluid and blood waste build up in the body and may result in various health issues like stroke and heart disease. 

Thirty-seven million US individuals, or 15% of the population, are projected to have chronic renal disease. An estimated 37 million US adults, or more than 1 in 7 persons, suffer from chronic renal disease. Additional negative effects of CKD on health include

  • Decreased life quality or depression
  • Low levels of calcium, high levels of potassium, and high levels of phosphorus found in the blood.
  • An increase in the frequency of infections
  • A decrease in appetite or eating
  • Low levels of red blood cells or anemia

There are various severity degrees for CKD. Even though treatment has been demonstrated to delay progression, it typically gets worse with time. CKD can lead to renal failure and early cardiovascular disease if it is not addressed. 

For survival after renal failure, dialysis or a kidney transplant is required. End-stage renal disease refers to abdominal gland failure treated with dialysis or a kidney transplant (ESRD). Understand ESRD better.

Not all Urinary organ sufferers get renal failure. Control risk factors for CKD, get tested annually, make lifestyle changes, take medication as prescribed, and routinely visit your healthcare team to help prevent CKD and reduce the chance of renal failure.

By the Numbers: CKD

  • In the US, kidney illnesses are one of the leading causes of death.
  • Adults in the US are thought to have CKD in about 37 million cases, most of which go untreated.
  • 40% of individuals with significant renal impairment (not receiving dialysis) are unaware that they have CKD.
  • Three hundred sixty people start receiving dialysis for renal failure every 24 hours.
  • Three out of every four new occurrences of renal failure in the US are caused by diabetes and excessive blood pressure.

Types of Kidney Disease

  • Glomerulopathy
  • Acetaminophen-induced Nephrotoxicity
  • Acute Phosphate Nephropathy
  • Papillary Necrosis
  • Abdominal Compartment Syndrome
  • Acute Lobar Nephronia
  • Ovarian Hyperstimulation Syndrome
  • Acute Kidney Failure or Injury
  • Abderhalden – Kaufmann – Lignac syndrome or Nephropathic 
  • Hepatitis C
  • Cystinosis

Why do dialysis treatments impact life insurance?

Dialysis procedures are a sign that someone has end-stage renal failure or some underlying, frequently fatal ailment. The National Kidney Foundation estimates that the average lifespan of dialysis patients is only five to ten years. 

Because of this, the majority of insurance companies are reluctant to take on such a high-risk client. Rarely, acute renal failure may become better with treatment. But most patients continue to receive dialysis on a permanent basis.

After a successful kidney transplant and a three-year break from therapy, you might finally be eligible for standard life insurance protection. Always follow up with your doctor and continue taking prescribed drugs to prevent a subpar rate. Avoid smoking and other risky pastimes as well.

Is Dialysis Covered by Insurance

Depending on the severity of your abdominal gland problems and your treatment plan, you may be able to obtain life insurance. Working with a broker is a smart option if you have renal problems. Brokers are not bound to any one life insurance provider so that they can find you the greatest offer. 

Types of Health Insurance

There are various types of comprehensive medical insurance available to satisfy multiple demands. The following are the most prevalent types of insurance for people with renal disease:

  • Medicare, including Medicare Advantage Medicaid and Original Medicare
  • Individual coverage
  • Group health insurance options for employers

What is the Best insurance for Dialysis Patients?

The following are the most common types of medical insurance that are best for adults and dialysis patients:

Medicare Medicare covers more than 90% (9 out of 10) of Americans with renal failure. Medicare beneficiaries over the age of 65, and in some jurisdictions, those under the age of 65, have access to a Medigap plan.
Private health insurance Through an employer or the ACA’s health insurance marketplace, such as healthcare.gov
Medicaid Government health plans for low-income or disabled persons.

Parts of Medicare

Part A: Hospital insurance Part B: Medical insurance Part D: Prescription drug coverage
Assistance pays for long-term care 
  • In-home nursing care 
  • Some hospice services
  • Laboratory examinations
  • Some home healthcare services
Aids in the payment of the bulk of the other services and items that Part A does not cover, such as
  • Visits to the doctor
  • Training, equipment, and supplies for home dialysis
  • Dialysis in a clinic or at home
  • Outpatient hospitalization
  • Medications used during dialysis
  • It pays for 80% of dialysis costs.
Aids in the payment of prescription drug costs
Costs that you may bear for Part A Costs that you may bear for 

Part B

Costs that you may bear for Part D
(Premium)

If you have paid the required amount in taxes through your employer, there is no monthly bill.

(Premium)

You will be charged on a monthly basis.

Your income determines the amount you pay. Most plans will cost you: Monthly payment (bill) and Deductible Copay, which is a predetermined amount you pay each time you fill a prescription.
(Deductible)

Before Medicare covers health treatment costs, you pay a specific amount of money.

(Deductible)

Before Medicare will reimburse you, you must pay a particular amount.

(Co-insurance)

After you have met your deductible, you may be required to pay a percentage of the costs.

(Co-insurance)

Outpatient services, such as dialysis, must be paid for in full.

Other Medicare options

Medicare Advantage plans (previously called Part C) Private health insurance companies provide these programs under contract with Medicare. They cover both Part A and Part B advantages, as well as some Part D advantages.
Supplemental (Medigap) plans Supplemental plans assist cover costs that Medicare Parts A and B do not cover, such as coinsurance, copay, and deductibles. It can, for example, help pay for the 20% of outpatient dialysis procedures which Part B somehow doesn’t cover.

Medicare tips for kidney patients

You should evaluate your Medicare plan once a year to determine if there have been any changes that will affect your coverage for the following year. People with renal problems can apply for Medicare Advantage plans! MA Plans give all of your Medicare (Part A & Part B) benefits, as well as extra coverage features such as prescription drug coverage or dental benefits where affordable dental care for adults is also included, to their members. 

MA plans frequently have tight in and out-of-network coverage zones, & clinic visits may demand a co-pay. Your dialysis facility and transplant center must be both in-network with the MA plan you select. 

To ensure that the MA plan meets your needs, study as much as you can about what it covers. Your insurance options for persons with renal illness may alter as your kidney disease advances. When someone begins dialysis or receives a kidney transplant, they can qualify for Medicare. 

Medicare is typically an insurance option for adults over the age of 65; however, there is a particular entitlement for persons with End-Stage Renal Disease (also known as kidney failure) (ESRD). Medicare covers 80% of the cost of dialysis and 80% of immunosuppressant drugs following the transplant.

health insurance for kidney patients

Key Notes about Your Dialysis Insurance Coverage

  • What source does the coverage have? 

(For example, use ongoing employment, COBRA, retirement plans, or publicly funded insurance programs like Medicaid or Medicare.)

  • Which kind of coverage do you have? 

(Medicaid, Original Medicare, employer-sponsored health plans, etc.)

  • Who holds the policy, exactly? 

        Your partner, You, your parents, etc.

Freedom of Choice

People prefers knowing that they have options in life. We prefer to make our own choices, from where we shop to where we reside. Every day, we make decisions, many of which are related to health care. Some of the most significant decisions we make concern our health care. 

This is influenced by having a doctor who actually listens to your problems, an insurance plan that covers all of your health needs, and quality care (where you feel comfortable). When it comes to having a choice, dialysis is no different. 

You should receive dialysis treatment in the dialysis center of your choice as a dialysis patient. Consider location, whether your nephrologist visits the center on a regular basis, and whether the center is in-network with your insurance. You have rights as a patient, and we are here to assist you with your insurance questions.

How Much Does Dialysis Cost with Insurance?

If you have any questions about the cost of dialysis, contact:

Talk with your social worker The phone number can be found on the back of your insurance card.
Call your insurance company They can assist you in understanding your insurance plan and applying for or reapplying for health care.

Bottom Line

Your options for insurance coverage are constrained if you’re one of the 468,000 Americans receiving dialysis. After a few years of regulated health, you might successfully pursue typical life insurance coverage if your condition improves with a kidney transplant. Unfortunately, the majority of patients must spend the remainder of their lives in therapy and can only buy guaranteed issue whole life insurance.

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