Dialysis And Life Insurance: What You Need To Know

Getting life insurance when on dialysis can be challenging, but it is possible. While a diagnosis of kidney disease won't disqualify you from getting life insurance, it can complicate the application process. Those on dialysis or with advanced kidney disease may not be eligible for traditional life insurance coverage but can consider other options like guaranteed issue life insurance, group life insurance, or a spousal insurance rider. Understanding insurance options and choosing the right plan can be confusing, and it's important to seek expert advice to find the best coverage for your specific situation.

Guaranteed issue life insurance

The main benefit of guaranteed issue life insurance is that applicants cannot be turned down due to their medical history. The only requirements to qualify for this type of insurance are that the applicant must be a U.S. citizen, between the ages of 40 and 85, and live in a state where it is available.

There are some drawbacks to guaranteed issue life insurance. Firstly, there is usually a mandatory graded period, typically lasting two years but sometimes up to two and a half years, during which the policyholder must pay premiums but is not yet eligible for the full coverage amount. If the policyholder dies during this period from natural causes, the beneficiaries will only receive the premiums paid to date plus interest. However, if death occurs due to an accident during the graded period, the beneficiaries will receive the full policy amount.

Another drawback is the cap on policy coverage amounts. Due to the nature of guaranteed issue life insurance, the coverage amount is usually limited to a maximum of $25,000 for people on kidney dialysis. While this may not be sufficient to cover all medical bills or outstanding debts, it can help cover final expenses such as cremation or burial services.

When considering guaranteed issue life insurance, it is important to shop around and compare rates from multiple carriers. Working with an independent agency can be beneficial as they can provide options from various carriers and help find the best policy for your needs.

Medicare

• Part A (Hospital Insurance) – Covers all inpatient services
• Part B (Medical Insurance) – Covers all clinical outpatient services
• Part C (Medicare Advantage Plans) – Such as HMO or PPO
• Part D (Medicare prescription drug coverage) – Offered to anyone with Medicare

Eligibility for Dialysis Patients

If you have End-Stage Renal Disease (ESRD), regardless of your age, you may qualify for Medicare Part A and be eligible for full benefits under Medicare Part B if the following conditions are met:

• Your kidneys have stopped functioning
• You require regular dialysis treatments or have undergone a kidney transplant
• One of the following applies to you:
• You have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee
• You are already receiving or are eligible for Social Security or Railroad Retirement benefits
• You are the spouse or dependent child of a person who meets the requirements listed above

Dialysis Treatment Options

There are two main types of kidney dialysis: hemodialysis and peritoneal dialysis. Hemodialysis involves a machine that cleans waste from your blood, while peritoneal dialysis uses a tube to transfer a cleansing solution into the abdomen to absorb waste and excess fluid.

Costs

Kidney Transplants

Coverage End Date

If kidney failure is the only reason you have Medicare, your coverage will end 12 months after the month you stop dialysis treatments or 36 months after the month you receive a kidney transplant.

Private health insurance

If you are starting dialysis, you may be eligible for Medicare insurance, usually after a waiting period. Medicare Part B typically covers 80% of the costs of dialysis treatment, leaving you responsible for the remaining 20%. You may also consider a supplemental plan, such as a Medigap policy, to help cover the remaining costs.

Additionally, private insurance plans offered through an employer or the Affordable Care Act (ACA) health insurance marketplace can provide coverage for dialysis treatment. These plans often have different costs and benefits, so it is important to carefully review the details of the plan before enrolling.

It is worth noting that some people choose to maintain their private insurance plans even after becoming eligible for Medicare. This is because private insurance may offer benefits that Medicare does not cover, such as dental or dependent coverage. Additionally, private insurance can provide lower cost-sharing, reducing the overall financial burden of dialysis treatment.

However, recent changes, such as a U.S. Supreme Court decision, have threatened access to private insurance coverage for dialysis patients. This has resulted in advocacy efforts to restore protections for dialysis patients and ensure they have a choice in their health coverage.

In conclusion, while private health insurance can be an option for people on dialysis, it is important to carefully review the specifics of your plan and understand any potential limitations or exclusions. Additionally, staying informed about any changes to insurance policies and advocating for protections is crucial to ensuring continued access to the coverage you need.

Dialysis patients' insurance options

Dialysis Patients Insurance Options

Dialysis patients have several insurance options available to them, depending on their circumstances. Here is a detailed overview of the various insurance options for dialysis patients:

Medicare

Medicare is a federal health insurance program that covers 80% of dialysis treatment costs and 80% of immunosuppressant medication costs after a kidney transplant. This program is typically available to people over 65, but there is a special provision for those with End-Stage Renal Disease (ESRD), i.e., permanent kidney failure.

Medicare has two main options: Original Medicare (Part A and Part B) and Medicare Advantage Plans (Part C). Most people with kidney failure are not eligible for Medicare Advantage Plans, but the 21st Century Cures Act allows people with ESRD to choose this option instead of Original Medicare from 2021 onwards.

Medicare Advantage Plans may restrict where patients can receive care, but they do cap out-of-pocket expenses. Original Medicare has no cap on out-of-pocket costs but offers more flexibility in terms of where patients can receive treatment.

Private Health Insurance

Private health insurance can also help cover the costs of kidney failure treatment. This includes group health insurance, which is often purchased through an employer, union, or a family member's employer or union. Individual health insurance is another option, where people buy coverage for themselves and their families.

Medigap/Medicare Supplemental Insurance

Medigap plans, also known as Medicare Supplemental Insurance, help cover some costs that Original Medicare does not, such as copays, coinsurance, and deductibles. These plans are available to anyone over 65, and some states offer them to people under 65 as well.

Medicaid

Medicaid is a federal-state program that provides free or low-cost health coverage for low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. Each state has its own Medicaid program, and it may cover services that Medicare does not.

Other Options

Dialysis patients may also explore other federal programs, state programs, and private organizations for financial assistance. For instance, the Social Security Administration offers financial help through the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. State kidney programs, state pharmaceutical assistance programs, and charities like the National Kidney Foundation can also provide financial support and resources.

Guaranteed Issue Life Insurance

Dialysis patients seeking life insurance may find it challenging to obtain traditional life insurance due to their high-risk health status. However, they can opt for guaranteed issue life insurance, also known as no-questions life insurance or guaranteed issue burial insurance. This type of insurance does not ask any medical questions and is designed for customers with pre-existing, high-risk conditions. The main requirements are that applicants must be U.S. citizens, between 40 and 85 years old, and reside in a state where this insurance is available.

While guaranteed issue life insurance ensures acceptance and provides guaranteed death benefits, it has a mandatory graded period, typically 2 to 2.5 years, during which beneficiaries will only receive the premiums paid to date plus interest if the policyholder dies from natural causes. After the graded period, full coverage takes effect. Additionally, there is a cap on policy coverage amounts, usually around $25,000 for people on kidney dialysis.

In conclusion, dialysis patients have a range of insurance options available, including Medicare, private health insurance, Medigap, Medicaid, and guaranteed issue life insurance. Each option has its own eligibility criteria, benefits, and limitations, so it is essential to carefully review and understand the specifics of each plan before making a decision.

Dialysis treatment costs

Another study analysed the costs of different dialysis modalities in the Cardiff and Vale NHS Trust and six other hospitals in the UK. The results showed that automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) were the most cost-efficient options, with mean annual costs of £21,655 and £15,570, respectively. In comparison, hospital-based haemodialysis (HD) was significantly more expensive, costing £35,023 per year.

For foreign visitors to the UK, the cost of dialysis can vary between centres, with standard haemodialysis sessions in NHS hospitals costing around £182, while private units in prime locations can charge between £350 and £400.

In the United States, Medicare covers 80% of the costs for dialysis treatment. People with kidney failure may also seek financial assistance from other sources, such as private health insurance, joint federal-state programs, private organisations, and medication assistance programs. The cost of dialysis treatment in the US can vary depending on the specific circumstances and coverage of the individual.

Frequently asked questions