Dialysis And Life Insurance: What's The Connection?

Dialysis is a treatment that cleans the blood when the kidneys don't work, removing harmful waste, salt, and fluids that build up in the body. It is not a cure for permanent kidney failure, but it can help patients live longer. If you stop dialysis, toxins will build up in the blood, causing a condition called uremia. Death usually follows within a few days to several weeks. If you have Medicare, your coverage will not end if you decide to stop dialysis. However, you should speak with your doctor about the type of care you will need and check if your insurance will cover it.

Medicare coverage

If you have End-Stage Renal Disease (ESRD) and require dialysis or a kidney transplant, you may be eligible for Medicare coverage. Here is a detailed overview of Medicare coverage for dialysis and related expenses:

Eligibility for Medicare Coverage:

To be eligible for Medicare coverage due to ESRD, certain conditions must be met. Firstly, your kidneys should no longer be functioning, and you need regular dialysis or have already received a kidney transplant. Additionally, one of the following criteria must apply:

• You have worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), 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 someone who meets the above requirements.

Parts of Medicare Coverage:

• Part A (Hospital Insurance): This covers inpatient dialysis treatments when you are admitted to a hospital. It also includes the cost of an inpatient kidney transplant or dialysis at a Medicare-approved facility after meeting the deductible, which was $1,632 in 2024.
• Part B (Medical Insurance): Part B helps cover outpatient dialysis treatments, doctors' services, and ESRD-related laboratory tests obtained in a Medicare-certified dialysis facility or your home. It also covers home dialysis training if you are a candidate, including training for you and your caregiver. Part B also covers home dialysis equipment, supplies, and certain home support services from your dialysis facility.

Costs and Copayments:

With Original Medicare, you will typically pay a 20% coinsurance for covered dialysis services after meeting the Part B yearly deductible. Medicare will pay the remaining 80%. The dollar amount of your coinsurance may vary depending on your specific plan. If you have a Medicare Advantage Plan or a Medicare Supplement Insurance (Medigap) policy, your costs may be different.

Exclusions from Medicare Coverage:

It is important to note that Medicare does not cover certain expenses related to dialysis:

• Paid dialysis aides to assist with home dialysis.
• Lost pay for you or your caregiver during home dialysis training.
• Accommodation expenses during your treatment.
• Blood or packed red blood cells for home dialysis, unless they are part of a doctor's service.

Timing of Medicare Coverage:

The timing of Medicare coverage for ESRD is unique. If you are eligible for Medicare due to ESRD and do not sign up immediately, your coverage can start up to 12 months before the month you apply. For those on dialysis, Medicare coverage usually starts on the first day of the fourth month of dialysis treatments. If you participate in a home dialysis training program during the first three months of dialysis, coverage can begin earlier.

If you receive a kidney transplant, Medicare coverage can begin the month you are admitted to a Medicare-certified hospital for the transplant or related healthcare services. If the transplant is delayed beyond two months, coverage can start two months before the transplant.

Additional Coverage Options:

Medicare Advantage Plans are offered by private companies as an alternative to Original Medicare. These plans typically include Parts A, B, and D (drug coverage). Some plans also offer extra coverage for vision, hearing, and dental care. It is important to check with your preferred providers to ensure they participate in the plan's network.

Medicare and Private Insurance:

If you have private insurance through the Affordable Care Act (Obamacare), applying for Medicare will result in losing your private plan coverage. This is because Affordable Care Act insurance plans are intended for individuals without other insurance options.

Supplemental Insurance:

It is recommended to have supplemental insurance to help cover expenses that Medicare does not fully cover. Options include Medigap Plans (available to those over 65 and, in some states, to those under 65) and Medicaid (based on income qualifications, which vary by state).

Private insurance

If you have private insurance through the Affordable Care Act (Obamacare), you will lose your private plan coverage if you apply for Medicare. This is because Affordable Care Act insurance plans are for people with no other insurance options. Once you have Medicare, you are considered to have other coverage and would no longer qualify for coverage through the Affordable Care Act.

Medicare covers 80% of the costs for dialysis treatment and 80% of the cost of immunosuppressant medications needed after a kidney transplant. However, it is recommended that you get supplemental insurance to help cover what Medicare doesn't.

Medigap Plans are available to anyone over 65 years old, and some states also offer these plans to people under 65. You must apply for these plans within 6 months of becoming eligible for Medicare. To find out what Medigap plans are available in your state, contact your State Health Insurance Assistance Program (SHIP).

Medicaid is another option, but you need to qualify based on income. Income requirements vary by state.

If you are undocumented, you may have a limited form of Medicaid coverage, although transplants are often not covered.

Hospice care

When a patient decides to stop dialysis, they are considered to be in a terminal state and are eligible for hospice care. The patient's social worker can help them and their loved ones make arrangements for this care. Hospice care can be provided in the patient's home through a home hospice program, or in a hospice facility. The social worker can also assist in arranging for a home health aide to help the patient and their family if needed.

The type of hospice care available may depend on the patient's insurance coverage and overall medical condition. Medicare coverage, for example, will continue even if the patient decides to stop dialysis, but it is important to check with the insurance provider to ensure that the specific care required will be covered.

During the final days, the patient may experience physical and emotional changes as the body starts to shut down. This may include loss of appetite, fluid overload, sleeping most of the day, visions of people who don't exist, disorientation, confusion, and changes in breathing, congestion, skin colour, and temperature. Medications can be given to manage pain, anxiety, agitation, and congestion. As the body's systems shut down, the person will slip into unconsciousness, and eventually, death will occur.

Palliative care

If a patient decides to stop dialysis, they will receive palliative care, also known as comfort care. This form of care focuses on keeping the patient as comfortable as possible during the time they have left. Hospice, a type of palliative care, can be recommended by the patient's physician and can take place at home, in a hospice facility, or in a hospital. Hospice provides pain relief and symptom control.

Once dialysis is stopped, toxins will build up in the blood, causing a condition called uremia. The patient will be given medication to manage the symptoms of uremia and other medical conditions. Death usually occurs within a few days to several weeks, depending on the patient's individual health condition and remaining kidney function.

As the body shuts down, the patient may experience:

• Loss of appetite and fluid overload
• Sleeping most of the day
• Visions of people who don't exist
• Disorientation, confusion, and failure to recognize familiar faces
• Changes in breathing, congestion, and changes in skin colour and temperature

Medications can be given to alleviate pain, anxiety, agitation, or congestion. As the body's systems shut down, the person will slip into unconsciousness before passing away.

Diet and lifestyle

Diet Adjustments

If you have kidney failure, your doctor will likely advise you to follow a kidney-friendly diet. This may include reducing your sodium or salt intake, choosing fresh fruits and vegetables, and avoiding foods high in phosphorus, such as oatmeal and other bran products. You may also be advised to eat smaller portions of protein, prepare fresh meals at home, and avoid processed foods. Additionally, it is important to limit your fluid intake while on dialysis, as healthy kidneys control fluid balance in the body.

Medication and Health Changes

Treating kidney failure may require new or additional medications. You may also be managing other health conditions, such as high cholesterol, in addition to chronic kidney disease. It is important to discuss any medications you are taking with your doctor and to be aware of any side effects, such as increased thirst.

Lifestyle Changes

Starting dialysis treatment will likely result in some lifestyle changes, including schedule shifts due to treatment durations and appointments. It may take some time to adjust to the processes and physical sensations of dialysis. Home dialysis may offer more flexibility and convenience, allowing you to continue working, studying, or enjoying hobbies. It can also provide a more flexible diet and require fewer medications.

Emotional Wellbeing

Managing dialysis can be emotionally challenging, so it is important to maintain your emotional well-being. Staying connected with your support system and engaging in activities you enjoy can help improve your quality of life.

Frequently asked questions