Dialysis Group Responds to Possible Insurance Restrictions for Kidney Patients on Medicare

Dialysis Group Responds to Possible Insurance Restrictions for Kidney Patients on Medicare

Dialysis Patient Citizens published a response letter to a request from the Centers for Medicare and Medicaid Services (CMS), asking for information about third-party payments that help make exchange plans affordable for people with end-stage renal disease (ESRD).

Dialysis Patient Citizens is a patient-led organization representing dialysis and pre-dialysis patients in the U.S. According to the group, patients with advanced kidney disease may be forced to drop their health insurance should the federal government act  to prevent them from accepting “charitable  premium assistance” for plans purchased in healthcare exchanges under the Affordable Care Act (ACA). CMS has suggested, the group said in a press release, that it may decide to prohibit ESRD patients on Medicare with exchange plans from accepting such assistance, such as that given by the American Kidney Fund, used to help them afford their premiums or other essential care.

The organization claims such a move would constitute the first step in rolling back the ban on pre-existing conditions enacted under the healthcare reform act, also known as Obamacare.

Medicare is the federal health insurance program for people who are age 65 or older, that also aids certain younger people with disabilities, and, specifically, ERSD patients regardless of age.

“The Affordable Care Act ended discrimination against people with chronic diseases in the individual insurance market, but that core protection could be voided for dialysis patients,” Hrant Jamgochian, chief executive of Dialysis Patient Citizens, said in a press release. “People with advanced kidney disease should not have to fear the loss of charitable support that helps them afford private insurance purchased on the exchanges created by the ACA.”

CMS is focused on patients who are eligible for Medicare but also receive premium assistance. “Any suggestion that patients should not receive financial assistance if they are eligible for Medicare is nothing more than a discriminatory strategy to eliminate patient choice and access to care for kidney disease patients,” Jamgochian said.

“Dialysis patients often need care coordination services that are not covered in Medicare, and they benefit from the ACA’s cap on out-of-pocket expenses, which doesn’t apply in Medicare,” he said. “In addition, we have serious concerns about the disincentive on insurers to provide the full range of preventive and treatment services to patients who they know will soon switch to Medicare. We urge CMS to preserve the right of dialysis patients to receive help paying for private insurance plans that offer them the care they need.”

To illustrate how exchange plans offer better combined services than Medicare plans, the organization highlighted the experiences of three ESRD patients — from Texas, Illinois and Idaho — who supplemented their Medicare coverage with commercial insurance out of necessity, in its response to CMS.

In Texas, a patient reported that his exchange plan paid for his diabetes treatments, which were not covered by Medicare; in Illinois, a patient reported that his private coverage helped to pay for nutritional supplements prescribed by his nephrologist and which, if he restricted his coverage to Medicare, he would have to pay for on his own; and in Idaho, a patient said that keeping her private plan allowed her to pay for psychologic counseling for her depression – her psychologist did not participate in the Medicare program.

According to Dialysis Patient Citizens, private insurers will have no incentive to offer the quality kidney care necessary to manage a patient’s transition from chronic kidney disease to ESRD if they are not obligated to do so.

In fact, the organization argued, it would be in the insurers’ financial interest to restrict patient access to essential services like kidney transplants, surgical treatments, and educational outreach programs that inform patients of ways to be proactive and take preventive measures regarding their disease.

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