Dialysis And Life Insurance: Is Dialysis Covered?

Dialysis is a life-saving treatment for people with kidney disease, but it can be expensive. Fortunately, there are several insurance options available to help cover the costs of dialysis. In the US, the Federal Government provides financial assistance through Medicare, which covers 80% of dialysis treatment costs for eligible individuals. Additionally, private health insurance, employer group health plans, and state-sponsored programs like Medicaid can also provide coverage for dialysis treatments. In India, health insurance companies like Care Health Insurance offer Critical Illness Insurance policies that cover dialysis treatments, ensuring that individuals can access the necessary care without financial barriers. Understanding insurance options and choosing the right plan can be overwhelming, so it is essential to carefully review the coverage details and seek assistance when needed.

Medicare coverage for dialysis

Medicare typically covers three hemodialysis or equivalent peritoneal dialysis treatments per week for those with ESRD. This includes inpatient dialysis treatments in a hospital, covered by Medicare Part A, and outpatient dialysis treatments in a Medicare-certified dialysis facility or at home, covered by Medicare Part B.

Medicare Part B covers home dialysis training for those who are candidates for home dialysis. This includes training for the patient and the person assisting with the treatment. Part B also covers the cost of home dialysis equipment and supplies, such as the dialysis machine, water treatment system, basic recliner, alcohol wipes, sterile drapes, rubber gloves, and scissors.

Medicare Part B covers drugs for outpatient and home dialysis, including heparin, topical anesthetics, and erythropoiesis-stimulating agents. However, it is important to note that Part B does not cover phosphate binders, which are only covered under Medicare Part D.

Medicare also covers other dialysis-related services, such as laboratory tests, nursing services, and nutritional services. Ambulance services to and from the dialysis facility are covered if travelling in any other vehicle could endanger the patient's health.

Costs and Copayments

For those with Original Medicare, there is a 20% copayment for covered dialysis services, with Medicare paying the remaining 80%. The dollar amount of coinsurance may vary depending on the specific Medicare Advantage Plan or Medicare Supplement Insurance (Medigap) policy.

Eligibility and Enrollment

Eligibility for Medicare coverage due to ESRD is based on specific criteria, including permanent kidney failure and the need for regular dialysis or a kidney transplant. Enrollment can be done by contacting the local Social Security office or calling Social Security.

Limitations and Exclusions

It is important to note that Medicare does not cover certain expenses related to dialysis, including paid dialysis aides, lost wages during home dialysis training, accommodation during treatment, and blood or packed red blood cells for home dialysis unless they are part of a doctor's service.

Additionally, Medicare does not cover surgery or services required to prepare for dialysis before the start of coverage, such as creating an access point for the dialysis machine.

Dialysis costs and insurance options

Dialysis is a costly but often necessary treatment for patients with chronic kidney disease, kidney failure, or end-stage renal disease. The cost of dialysis will vary depending on your insurance status, the type of dialysis, and where you receive treatment.

Dialysis Costs with Insurance

Medicare, Medicaid, and private insurance plans cover most of the health care costs of dialysis. Medicare Part A and Part B cover the majority of dialysis costs, with Medicare Part A covering inpatient dialysis treatments in a hospital, and Part B covering outpatient treatments and doctors' services in a Medicare-certified dialysis facility or your home. Part B also covers home dialysis training, equipment, and supplies. Medicare Advantage combines the benefits of Part A, Part B, and often your Part D coverage into one plan, and may include additional benefits not usually covered by Original Medicare.

Medicare generally covers 80% of dialysis costs, leaving you to pay the remaining 20%. If you have Original Medicare, after you pay the Part B yearly deductible, you’ll continue to pay 20% of the cost for all covered dialysis services. If you are eligible for Medicare, your Employer Group Health Plan (EGHP) will be your primary insurance for 30 months after starting dialysis. After this 30-month coordination period, your EGHP will become your secondary insurance and Medicare will become primary.

Dialysis Costs Without Insurance

The cost of dialysis without insurance can vary anywhere from $10,000 to $90,000 annually, depending on the type of dialysis and where you receive treatment. In-center hemodialysis can cost $250-$350 per session, and peritoneal dialysis, which is typically done at home, costs around $145-$180 per day. One dialysis treatment for uninsured patients can cost over $500, and prices can be as high as $10,000 per session if receiving dialysis from the emergency department of a hospital.

Insurance Options

There are several insurance options to consider if you are on dialysis:

• Medicare – Government health insurance plans for people who are 65 or older, or under 65 with certain health conditions, such as end-stage renal disease or stage 5 chronic kidney disease.
• Medicare Advantage – Managed by private companies approved by Medicare, these plans combine the benefits of Part A, Part B, and often Part D, into one convenient plan.
• Medigap – Medicare supplemental insurance sold by private insurance companies to supplement healthcare costs not covered by Medicare alone.
• Medicaid – Health coverage plans offered by states based on financial eligibility.
• Employer Group Health Plans – Insurance offered through your job or your spouse's job, which may offer better rates and overall benefits.
• COBRA – If you lose your insurance coverage through your employer, you may be able to continue your insurance for a specified time through COBRA.
• Affordable Care Act (ACA) Health Insurance Exchange plans – Private commercial insurance plans, sometimes referred to as "Obamacare" plans, which are Qualified Health Plans that provide the minimum essential benefits required by law.
• Private/individual health plans – Private commercial health insurance offered directly through an insurance company or through an insurance agent.

Dialysis without insurance

Dialysis is a treatment for people with end-stage renal disease (ESRD) or end-stage kidney disease (ESKD), whose kidneys no longer work. It is a procedure that cleans the blood, removing waste, salt, and fluid from the body, and helping to control blood pressure. This treatment can be incredibly costly, and without insurance, dialysis can cost $500 or more per session.

If you are facing dialysis without insurance, there are several options to explore to help cover the costs. Firstly, Medicare is a federal health insurance program that covers dialysis treatments for eligible individuals. Since 1972, all individuals diagnosed with ESRD have been eligible for Medicare benefits, regardless of age. Medicare Part A and Part B cover the majority of dialysis costs, including inpatient and outpatient dialysis, home dialysis training, dialysis equipment and supplies, and prescriptions. Once enrolled, Medicare will typically cover 80% of your dialysis costs, while you pay the remaining 20%.

If you do not qualify for Medicare, there are other options to explore:

• Medicaid: A joint federal-state program that provides free or low-cost health coverage for certain low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. Each state has its own Medicaid program with varying coverage specifics.
• Children's Health Insurance Program (CHIP): This program offers free or low-cost Medicaid to children whose parents earn too much for Medicaid but not enough for private health insurance.
• Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI): These programs provide financial assistance to individuals who are unable to work due to illness or injury, or who are disabled and have limited financial assets.
• State-specific programs: Some states offer Medicare Savings Programs, where the state may pay your Medicare premiums, deductibles, and/or coinsurance if you have a low income. State Health Insurance Assistance Programs (SHIPs) offer local advice about health insurance to Medicare beneficiaries or eligible individuals. State kidney programs provide financial assistance and other services to people with kidney disease. State Pharmaceutical Assistance Programs (SPAPs) help pay for prescription medications in certain states.
• Private health insurance: You can explore options through your employer, union, or a family member's employer or union. Individual health insurance plans are also available through the Health Insurance Marketplace for those without other insurance options.
• Financial assistance from private organizations: Charities and foundations, such as the National Kidney Foundation, may offer patient education, advocacy, and financial assistance in certain cases.

It is important to note that even with insurance, there may be out-of-pocket expenses associated with dialysis, including premiums, deductibles, co-insurance, and copayments. Additionally, if you are considering home dialysis, there may be additional costs for equipment, supplies, and increased utility bills.

If you are facing dialysis without insurance, it is crucial to explore these options and seek assistance from a social worker at your dialysis clinic to understand your insurance choices and apply for the necessary coverage.

Dialysis covered under medical insurance in India

Dialysis is a life-saving treatment for kidney failure, a critical and often life-threatening condition. In India, the cost of dialysis treatment ranges from ₹2000 to ₹8000 per session, with most patients requiring dialysis at least three times a week. This can be a huge financial burden on patients and their families, leading to emotional stress and the possibility of stopping treatment due to financial constraints. However, medical insurance in India typically covers dialysis under critical illness insurance plans, providing financial assistance to those suffering from kidney disease and related problems.

Details of Dialysis Coverage in India:

Most insurers in India provide coverage for dialysis under critical illness insurance plans. Here are some key points about dialysis coverage:

• Inclusions: Dialysis is typically covered under critical illness insurance plans, along with other kidney-related treatments such as kidney transplant surgery, chronic kidney disease, and end-stage renal disease.
• Exclusions: Dialysis health insurance plans usually exclude non-allopathic treatments, self-inflicted injuries, injuries due to adventure sports, and injuries caused under the influence of alcohol or drugs.
• Ideal Candidates for Dialysis Insurance: People with hypertension, a family history of kidney disease, aged 60 years and above, abnormal kidney structure, or a long history of taking painkillers are ideal candidates for dialysis insurance coverage.
• Benefits of Buying Dialysis Insurance: The high incidence of kidney disease in India, the expensive treatment costs, and the need for holistic financial protection make buying dialysis insurance a wise decision. It ensures that individuals don't have to spend their life savings on treatment and can stay financially prepared for kidney-related medical expenses.
• Recommended Insurance Plans: There are several recommended insurance plans for dialysis patients in India, including the Aditya Birla Activ Secure - Critical Illness Plan, Bajaj Allianz Criti Care Plan, Cholamandalam MS Critical Healthline Insurance Plan, and many others.
• Tax Benefits: Buying health insurance for dialysis treatment can provide tax benefits under section 80D of the Income Tax Act.

Example of an Insurance Provider:

An example of an insurance provider offering critical illness insurance for kidney failure in India is HDFC ERGO. Here are some details about their plan:

• Lump-Sum Payout: HDFC ERGO's critical illness insurance for kidney failure provides a lump-sum payout upon diagnosis. This payout can be used for treatment expenses, dialysis costs, medical care, recovery, debt repayment, and regular expenses.
• Eligibility: The policy covers individuals aged 5 to 65 years.
• Documentation: No documentation is required for this policy; simply fill in the details online and make the payment. In the case of a pre-existing disease, relevant medical documents may be required.
• Claims: Only one claim is allowed during the lifetime of the policy.

Dialysis treatment is essential for individuals with kidney failure, and the financial burden of this treatment can be significant. Medical insurance in India typically covers dialysis under critical illness insurance plans, providing financial support and peace of mind to patients and their families.

By investing in a suitable health insurance policy, individuals can ensure they receive the required treatment without worrying about massive medical bills.

Dialysis and transplant insurance options

Dialysis and kidney transplants are expensive treatments. Many people need financial help to cover the costs. Luckily, there are several insurance options available to help with dialysis and transplant costs.

Medicare

Medicare is a federal health insurance program that covers 80% of dialysis treatment costs and 80% of immunosuppressant medication costs after a transplant. People under 65 with end-stage renal disease (ESRD) are eligible for Medicare. If you have Original Medicare, you will need Part A (Hospital Insurance) and Part B (Medical Insurance) to get the full benefits available under Medicare for people with ESRD. Part A covers inpatient dialysis treatments in a hospital, while Part B covers outpatient dialysis treatments and doctors' services in a Medicare-certified dialysis facility or your home. Part B also covers home dialysis training and equipment.

Employer Group Health Plan (EGHP)

If you are eligible for Medicare, your EGHP will be your primary insurance for 30 months after starting dialysis or having a kidney transplant. After this 30-month coordination period, your EGHP will become your secondary insurance and Medicare will become primary.

Private Insurance

Private insurance can also help cover the costs of dialysis and kidney transplants. This includes insurance through the Affordable Care Act (Obamacare) and individual health insurance bought directly through an insurance company or agent.

Supplemental Insurance

It is recommended to have supplemental insurance to help cover what Medicare doesn't. Options include Medigap Plans and Medicaid.

Other Options

Other insurance options include Managed Care Plans and Medicare Advantage, which is a type of Medicare health plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits.

Frequently asked questions