Time for Congress to Guarantee Medigap Health Insurance for Vulnerable Americans with Kidney Failure


As people who have lived with kidney failure for years, we know only too well the many daily challenges that anyone living with this disease faces. Beyond the immediacy of arranging necessary and frequent dialysis care, there are many other life-changing issues for people with kidney disease: Will I still be able to work and support my family? How does committing to such a rigorous program of care impact the rest of my life? Will I one day be able to receive a transplant? Can I even afford the care I need to survive?

People diagnosed with kidney failure are weighed down by a whole host of uncertainties like these. But questions about how and if they can afford treatments that will keep them alive shouldn’t be part of the equation.

Decades ago, our country demonstrated its commitment to caring for people with kidney disease, also known as end-stage renal disease (ESRD), by allowing ESRD patients to enroll in Medicare regardless of their age. This safety net has been shown to change the lives of this vulnerable patient population, but it is simply not enough. Medicare coverage for ESRD covers only 80 percent of an individual’s health costs, leaving ESRD patients who do not have additional coverage with responsibility for the remaining 20 percent of the costs. costs, an amount that has no cap. Dealing with a lifetime of medical treatment is daunting, but adding the financial impact of this disease can be almost too much to deal with. Fortunately, there is a way to alleviate this problem: expand and improve access to health insurance. additional cover to make sure anyone who needs it can buy it.

Medigap coverage, also known as Medicare supplemental insurance, helps close the “gap” between Medicare coverage and remaining health care costs, but it is a safety net with troubling holes. Twenty states do not guarantee Medicare ESRD beneficiaries under age 65 access to Medigap, which means where you live can have a profound impact on your ability to pay for care. More than half of all people with kidney disease may not have access to this safety net. Recently released report card on Accessibility and Affordability of Coverage Medigap found that 61 percent of patients living with ESRD are under 65, but only 11 percent of people under 65 with Medicare benefit from Medigap coverage.

Unfortunately, even when individual states to do Forcing insurers to offer Medigap coverage for those under 65 is often financially out of reach. The same bulletin reported that only eight states received an “A” rating for requiring that “all or most” Medigap plans be offered and affordable for people with ESRD who are under 65 years of age. Twenty-one states were rated ‘D’ or ” F ‘for 1) lack of affordability; 2) not requiring Medigap coverage for those under 65 with ESRD; or 3) completely exclude these patients from Medigap eligibility.

The inequality don’t stop there. The ESRD patient population is disproportionately made up of black Americans and other minority populations facing financial disparities, whether or not they have ESRD. Black Americans make up 13 percent of the American population, but understand 35 percent of people on dialysis. Blacks are also less likely to be identified as candidates for a kidney transplant, less likely to be referred for transplant evaluation, and less likely to be placed on transplant waiting lists – where they ultimately wait more. longer than whites. These startling statistics underscore the immediate need to strengthen Medigap coverage to protect our most vulnerable groups from financial problems that can prevent them from getting the care they need.

Today, the condition you live in can be a key factor in whether or not an ESRD patient can afford care. For example, Alabama (ranked D) – a state with no consumer protection for Medicare-eligible patients under the age of 65 – has only a handful of insurers that offer Medigap plans, and these plans do. are free to charge the premiums they wish. Many patients with ESRD in Alabama cannot afford the high monthly premiums currently required to secure Medigap coverage, which can mean reduced access to care.

Similar to Alabama, the state of California (ranked F) explicitly exempts insurers from having to offer people with ESRD under the age of 65 Medigap plans while inexplicably requiring that these options be available to all. other people with disabilities. The incongruous Medigap and Medicare coverage for people requiring dialysis or kidney transplants, adds another layer of problems accessing and paying for care. Some patients even end up on Medicaid / Medical so they can afford the high cost of care.

It is simply incomprehensible that people with kidney disease under the age of 65 who are on Medicare cannot access Medigap. Patients with kidney disease struggle to survive, nor should they have to struggle with the inequalities built into the system that put you at risk for high, uncapped Medicare reimbursable costs of 20%.

This year, we hope Congress addresses the glaring disparities in affordability and access to IRT treatments by passing the bipartite agreement. Jack Reynolds Memorial Medigap Expansion Act (HR 1676) – which would expand Medigap coverage for those under 65 with ESRD and ensure access to life-saving medications, dialysis and kidney transplants. Presented by representatives Cynthia Axne (D-Iowa) and Jaime Herrera BeutlerJaime Lynn Herrera BeutlerWashington Redistribution Panel Reaches Late Deal on New Lines Trump Criticizes McCarthy for Greene’s Treatment in New Book House Passes Bill to Extend Workplace Protections for Breastfeeding Mothers MORE (R-Wash.), The policy change would help any American with kidney failure – regardless of age – afford and access the care they need, as Medicare originally intended to covering people with ESRD of all ages decades ago. The provision was also included in the Comprehensive Bipartite Community Kidney Care Bill, the Chronic Kidney Disease Improvement in Research and Treatment Act (HR 4065/S. 1971), presented by the representatives. Terri SewellTerrycina (Terri) Andrea Sewell It’s time to make access to quality kidney care accessible and equitable for all. (D-Ala.) And Vern BuchananVernon Gale BuchananPLUS (R-Fla.) And Sens. Ben cardinBenjamin (Ben) Louis Cardin Senators are calling for the Smithsonian Latino and Women’s Museums to be built on the National Mall. (D-Md.) And Roy BluntRoy Dean BluntTexas Democratic Representative Eddie Bernice Johnson announces retirement at end of term The former DC Guard commander calls for retraction of the Jan.6 report from the Pentagon watchdog. (D-Mo.).

Americans with ESRD shouldn’t face a life-threatening health diagnosis only to find out that they have no way to afford the care they need to survive, even with guaranteed Medicare coverage. We must do better as a nation to ensure that Medigap plans with affordable premiums are available to all Americans with kidney failure and in need of life-saving care.

Lori Hartwell is CEO of Renal Support Network; Andrew Conklin is President of Dialyse Patient Citizens; Cherrie Crockett is the Patient Ambassador for the American Kidney Fund

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