Understanding Insurance and Managing Dialysis Costs

Exploring your insurance and potential financial aid options for dialysis or a kidney transplant is an important part of kidney disease and end stage renal disease (ESRD) treatment. Dialysis and transplant costs can vary depending on your insurance coverage. You’ll want to make sure you have the best possible coverage, based on your eligibility. Start exploring your insurance options for treatment in the earlier stages of chronic kidney disease (CKD), so you can be prepared. And if you’re on dialysis, talk to your insurance coordinator about any changes and new options available, including Medicare Advantage.
Insurance coordinator ready to help.

Our insurance coordinators are here to help

When you’re starting treatment at Fresenius Kidney Care, your insurance coordinator will explain all your insurance coverage options—so you can choose what’s right for you. If your insurance needs or coverage change at any time, contact your insurance coordinator to help you:

  •  Understand dialysis costs
  •  Map out financial steps to support your kidney health
  •  Review your insurance plan information
  •  Explore health coverage options
  •  Understand insurance coverage for a transplant

Before you make any change to your insurance coverage, talk to your insurance coordinator

When looking at insurance options, you may see a lower premium or deductible and be tempted to switch to new coverage. However, that plan might end up costing you more overall. There are many costs to consider when figuring out which health plan is best for your needs. Contact your insurance coordinator to help compare your options and see the big picture before you make a decision. 


If you do change insurance, be sure to tell your care team immediately—and bring your new insurance cards to your next doctor appointment or dialysis treatment. It’s important that your correct insurance information is on file so that your treatment claims can get covered on time and for the right amount.


Understanding different types of health insurance

Healthcare coverage has 3 broad categories: employer/commercial coverage, individual coverage, and government­-sponsored coverage.

Commercial coverage includes:

Employer group health plansinsurance offered through your job or your spouse’s job has group buying power and may offer better rates and overall benefits.

LEARN MORE ABOUT EMPLOYER PLANS HERE
COBRA (Consolidated Omnibus Budget Reconciliation Act) plans—if you lose the insurance coverage you have through your or your spouse's employer, you may be able to continue your insurance for a specified time period through COBRA.

Affordable Care Act (ACA) Health Insurance Exchange plans—private commercial insurance plans are available through the ACA Health Insurance Exchange, which are sometimes referred to as “Obamacare” plans. These options are Qualified Health Plans (QHPs) that provide the minimum essential benefits required by law.

Private/individual health plans—private commercial health insurance is also offered directly through an insurance company or through an insurance agent. There are 2 main types of private healthcare plans: managed healthcare (using a specific network of doctors) and indemnity health (usable with most providers).

Government-sponsored coverage includes:

Medicare—government health insurance plans for people who are 65 or older, or under 65 with certain health conditions. People under 65 who have end stage renal disease (ESRD) or stage 5 CKD are usually eligible for Medicare.


Medicare Advantage—all-in-one health coverage plans managed by private companies that are approved by Medicare. Also called Medicare Part C, Medicare Advantage plans offer several types of coverage to replace having multiple traditional Medicare plans. Starting in 2020, people with ESRD can choose Medicare Advantage during open enrollment, with coverage beginning in January 2021.

LEARN MORE ABOUT MEDICARE AND MEDICARE ADVANTAGE PLANS HERE


Medigap—Medicare supplemental insurance, a secondary insurance sold by private insurance companies to supplement healthcare costs that are not covered by Medicare alone.

Medicaid—health coverage plans offered by states, including Children's Health Insurance Program (CHIP) and Medicare Savings Programs (MSPs). Medicaid coverage is available based on financial eligibility in each state. 

Federal and state employee plans—insurance plans for federal or state employees and their families. 

TRICARE, VA, and CHAMPVA—health coverage benefits for military members and families. 

Indian Health Service—the federal health program for American Indians and Alaska Natives. 

State high-risk insurance pools—state-sponsored health plans that provide coverage for people who don't qualify for individual insurance market plans, based on a pre-existing condition. 

State kidney programs—state-funded programs that provide assistance for people living with kidney disease, based on eligibility.

NEW IN 2021: MEDICARE ADVANTAGE FOR PEOPLE WITH ESRD

New legislation allows Medicare-eligible people diagnosed with ESRD to enroll in Medicare Advantage 
(Medicare Part C). Open enrollment begins October 15, 2021. Ask your insurance coordinator for details.
LEARN THE BASICS

LEARN ABOUT YOUR INSURANCE OPTIONS

There’s a special enrollment period for the Affordable Care Act. If you’re interested in learning about health insurance plan options, talk to your insurance coordinator or learn more through eHealth, an independent licensed insurance agent.
TALK TO eHEALTH

NEED HELP PAYING FOR MEDICATIONS?

Find out what’s covered by your insurance plan by talking to your insurance coordinator about available resources or programs. You can also ask your care team or social worker about Fresenius Kidney Care Pharmacy services.

UNDERSTAND­ING DIALYSIS TREATMENT COSTS

Find out more about coverage for dialysis and key insurance terms.
Learn More

What to consider when choosing health insurance

There are several factors to think through if you’re considering switching insurance. Looking at the big picture and comparing the total benefits and costs of each plan can help you choose the coverage that’s right for you. Here are 7 plan features to consider: 

  1. Network of providers—see if the plan has a network of approved providers to choose from. Getting care from an “in-network” provider (instead of going to an “out-of-network” provider) can help you manage costs.
  2. Out-of-pocket costs—this is the total amount of money you spend each year on medical services, including copays, coinsurance, deductibles, and premiums. The amount varies from plan to plan.
  3. Prescription coverage—see whether your plan coverage includes prescriptions or if you’ll need to add a supplemental plan. Also look at whether the coverage for prescriptions is a fixed amount or percentage, or whether your costs may vary throughout the year. Consider that dialysis or transplant medications may be covered differently than medications for other conditions.
  4. Medical supplies and equipment—depending on your treatment, you may need to have various supplies and equipment at home. Explore coverage for supplies, as well as delivery or shipment.
  5. Transportation coverage—some plans cover emergency medical transportation, such as an emergency hospital visit. Also see if the plan covers the cost of transportation to and from doctor appointments or other health facilities—this can be important if you have regular visits to a dialysis center.
  6. Family coverage—explore whether the plan offers spousal or family coverage, if you need it. If your spouse is covered by your current plan, you may need to think through additional options if you make a change.
  7. Transplant coverage—if you’re considering a kidney transplant, look at the coverage for transplant surgery, as well as ongoing transplant medications and donor surgery.

TIP:
While you’re looking at your health insurance options, be sure to keep the coverage you have and continue paying your premiums on time, so you don’t have any coverage gaps. If you’re concerned about affording your payments, there may be assistance available. Ask your insurance coordinator or social worker for more information on assistance programs.

How to pay for dialysis without insurance

If you are planning to go on dialysis and don’t have the coverage you need—or you’re concerned about costs—now’s the time to connect with your insurance coordinator. Your insurance coordinator is an expert at identifying the different kinds of health coverage and can help make sure you understand the options available to you. There may be additional resources and financial assistance available to help you minimize your costs. Talk to your insurance coordinator today.

CONTACTED BY YOUR INSURANCE COMPANY? LET US KNOW

If you get a letter, email, or phone call with requests for information from your insurance company, contact your insurance coordinator immediately. He or she will be able to help with 
time-sensitive decisions.