Dialysis And Life Insurance: What's Covered And What's Not

Dialysis patients are often reliant on Medicare to cover the costs of their treatment. However, some patients may wish to maintain their private insurance to continue dental or dependent coverage unavailable in Medicare, or to take advantage of lower cost-sharing.

In the US, federal law gives dialysis patients the right to maintain their private, employer coverage for up to 30 months. However, a recent Supreme Court decision has threatened access to private coverage by allowing health plans to impose restrictive terms on patients.

This has raised concerns about whether stopping dialysis violates life insurance coverage. While it is important to review the terms of your specific policy, in general, stopping dialysis treatment does not violate life insurance coverage. Life insurance policies typically do not include provisions that explicitly exclude coverage for individuals who choose to discontinue dialysis.

However, it is crucial to carefully consider the implications of stopping dialysis and discuss this decision with your healthcare team and loved ones.

Dialysis patients' access to private insurance

Dialysis patients are entitled to Medicare, and federal law also gives them the right to maintain their private, employer coverage for up to 30 months. This is important because it incentivizes health plans to detect and treat Chronic Kidney Disease, take measures to preserve patients' kidney function, and ensure a safe transition to ESRD when kidney failure is inevitable.

Dialysis patients may wish to maintain their private insurance to continue dental or dependent coverage unavailable with Medicare or to take advantage of lower cost-sharing. However, a recent U.S. Supreme Court decision now permits health plans to remove dialysis benefits from their networks and impose restrictive terms on patients.

Dialysis patients with private insurance often face large medical bills and struggle to afford treatments. Private insurance can help cover the costs that Medicare does not, allowing patients to focus on their health and loved ones rather than financial stability.

Dialysis patients can apply for Medicare when they first start dialysis or wait until the end of the 30-month coordination period. Once they apply, they will be responsible for the monthly Part B premiums.

Dialysis patients with private insurance through the Affordable Care Act will lose their private plan coverage if they apply for Medicare. This is because Affordable Care Act insurance plans are for people with no other insurance options.

Medicare coverage for dialysis patients

Medicare covers 80% of the costs for dialysis treatment, and 80% of the cost of immunosuppressant medications needed after a kidney transplant. The other 20% is covered by the patient's copayment.

Part A covers inpatient dialysis treatments in a hospital, while Part B helps cover outpatient dialysis treatments and doctors' services in a Medicare-certified dialysis facility or the patient's home. Part B also covers home dialysis training, certain home support services, and drugs for outpatient and home dialysis.

If a patient has Original Medicare, they will need Part A (Hospital Insurance), Part B (Medical Insurance), and possibly Medicare drug coverage (Part D) to get the full benefits available under Medicare for End-Stage Renal Disease (ESRD).

It is important to note that there are other types of insurance that may help pay for healthcare costs that Medicare does not cover, such as employee or retiree coverage, Medicare Supplement Insurance (Medigap), and Veterans' Administration benefits. Additionally, there are financial assistance programs and state kidney programs that can help with costs.

Dialysis patients' eligibility for hospice care

Dialysis patients are often eligible for hospice care, but there are some challenges and considerations to address. Firstly, it's important to understand that stopping dialysis is a valid choice for patients who feel it is no longer improving their quality of life. This decision should be made in consultation with their healthcare team and loved ones, weighing the medical and emotional implications.

When a patient chooses to stop dialysis, they are considered to be in a terminal state and are typically eligible for hospice care. Hospice care provides physical, emotional, and spiritual support to patients and their families during this difficult time. It helps manage symptoms, provides comfort, and ensures patients retain their dignity. However, there are some barriers to hospice care for dialysis patients.

One significant challenge is the rigid nature of the Medicare Hospice Benefit, which requires beneficiaries to revoke all life-prolonging treatments, including dialysis, to receive hospice services. This forces patients to choose between continuing life-prolonging treatments or accessing high-quality end-of-life services. As a result, few dialysis patients choose hospice care, and those who do often delay enrollment until very close to the end of their lives.

Another issue is the financial strain of providing concurrent hospice and dialysis care. Hospices receive a flat per diem rate from Medicare, which may not cover the cost of dialysis treatments. This makes it difficult for hospices to financially sustain concurrent care practices.

Despite these challenges, there are innovative models, such as concurrent care or open access, that allow patients to receive both hospice and dialysis services. These models provide a more gradual transition and improve end-of-life outcomes for dialysis patients. However, more widespread adoption of these models may depend on policy changes and financial support.

In conclusion, while dialysis patients are generally eligible for hospice care when they choose to stop dialysis, there are complexities and obstacles that can make accessing this care difficult. It is important for patients, families, and healthcare providers to be aware of these challenges and advocate for improvements in end-of-life care for dialysis patients.

Dialysis patients' insurance options

Dialysis Patients: Insurance Options

Dialysis patients have several insurance options, including Medicare, Medicaid, and private insurance plans. These plans can help cover the costs of dialysis treatment, which can be expensive. Here are some of the options available:

Medicare

Medicare is a government health insurance program for people aged 65 and over or those with kidney failure, also known as End-Stage Renal Disease (ESRD) or End-Stage Kidney Disease (ESKD). It covers 80% of the cost of dialysis treatment and immunosuppressant medications after a kidney transplant. Most people who start dialysis can get Medicare insurance, usually after a three-month waiting period.

Medicaid

Medicaid is a government health insurance program for people with low incomes or disabilities. It should cover most dialysis and transplant expenses, but the coverage may vary depending on the state and the patient's income.

Private Insurance

Private insurance plans can be obtained through an employer or the Affordable Care Act (Obamacare) health insurance marketplace. These plans can help cover the costs of dialysis, but patients may still need to pay premiums, deductibles, co-insurance, and copayments.

Medigap Plans

Medigap plans are supplemental insurance plans that help cover the costs that Medicare Parts A and B do not, such as copays, co-insurance, and deductibles. These plans must be applied for within six months of becoming eligible for Medicare and are available to anyone over 65. Some states also offer Medigap plans for people under 65.

Medicare Advantage Plans

Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide beneficiaries with all their Part A and Part B benefits. These plans may also offer additional benefits, such as prescription drug coverage or dental benefits.

It is important to note that insurance options may change as a patient's kidney disease progresses, and it is recommended to review insurance plans annually to ensure coverage meets the patient's needs. Additionally, patients should be aware that stopping dialysis treatment will not affect their Medicare coverage.

Dialysis patients' life insurance options

Dialysis patients have several life insurance options available to them, though it can be challenging to secure life insurance with a pre-existing high-risk condition. Here are some options for dialysis patients seeking life insurance:

Guaranteed Issue Life Insurance

Dialysis patients can purchase whole guaranteed issue life insurance, which does not require a medical exam or health questions. The monthly rates for this type of policy typically start at $474, and the death benefit is often limited. There is also a mandatory graded period, usually 2 years, during which the policyholder must outlive to qualify for full coverage. If the policyholder dies during this period from natural causes, the beneficiaries will receive the premiums paid to date plus interest. However, if death occurs from an accident, the beneficiaries will receive the full policy amount.

Term Life Insurance with Conversion Option

Dialysis patients may be able to secure a term life insurance policy with a conversion option, which allows them to convert it to a permanent policy without a medical exam in the future if their health improves or they receive a successful kidney transplant. The premiums for these policies are typically higher compared to traditional coverage.

Final Expense Insurance

Final expense insurance is designed to cover funeral and burial expenses and may be an option for older dialysis patients. This type of coverage does not require a medical exam or extensive underwriting.

Medicare

Dialysis patients may also be eligible for Medicare, which covers 80% of the cost of dialysis treatment and immunosuppressant medications after a kidney transplant. Medicare can be the primary insurance for 30 months after starting dialysis or receiving a kidney transplant, after which it becomes the secondary insurance.

It is important to note that life insurance rates and options for dialysis patients may vary depending on individual circumstances and insurance providers' underwriting guidelines. Seeking advice from an independent insurance agency or agent licensed in your state can help dialysis patients find the most suitable coverage for their needs.

Frequently asked questions