Dialysis Costs and Insurance Options
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.
Our insurance coordinators are here to help
When you’re starting treatment at Fresenius Kidney Care, your insurance coordinator can help you understand insurance. If your insurance needs change at any time, contact your insurance coordinator. Your insurance coordinator can:
- Review your insurance plan with you
- Discuss insurance options available to you
- Explain your insurance benefits for dialysis
- Help you understand the importance of 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. Before you make a change, contact your insurance coordinator to help you understand your insurance so you can 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.
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 plans—insurance 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.
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.
Medicare Advantage—Medicare Advantage plans combine the benefits of Part A, Part B, and often your Part D coverage into one convenient plan. Medicare Advantage plans may include additional benefits not usually covered by Original Medicare. Medicare Advantage plans are managed by private companies that are approved by Medicare.
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.
Questions about your insurance?
Talk to one of our insurance coordinators. We can help you understand your insurance.
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Find out what’s covered by your insurance plan by talking to your insurance coordinator about available resources or programs. You can also ask about pharmacy services in- network with your insurance plan.
Find out more about coverage for dialysis and key insurance terms.
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Health insurance considerations for people on dialysis
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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 can help you understand the insurance options available to you.
Right to receive a good faith estimate
If you do not have health insurance or are not using it, under the law you have the right to receive a good faith estimate for the cost of your scheduled services. You can request a good faith estimate at any time. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises, or call the No Surprises Help Desk at 1-800-985-3059. You can also call Fresenius Kidney Care’s Enhanced Patient Connect at 800-767-9420.
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.
time-sensitive decisions.