As an individual on dialysis, your insurance coverage plays an important role. You may ask yourself how will my treatments be paid for and how will I afford my medicine? Your medical insurance helps to pay for services you receive from your dialysis unit whether it’s performed at home or in a dialysis center. Your prescription coverage can assist in lowering the cost of the medications your doctors prescribes for you. Insurance can be overwhelming however DaVita® has dedicated resources available to help its patients navigate through their options.
Employer Group Health Plan (EGHP)
Medical insurance provided through an employer is called an employer group health plan (EGHP). People can have an EGHP through themselves or by being a spouse or dependent of the policy holder. You may also have coverage under an EGHP through retirement benefits or COBRA (continuation of benefits). Many times prescription coverage is attached to the medical insurance. Depending on your coverage, your EGHP may help with dialysis costs; medications your doctor prescribes; and other doctors/specialist you may go to. An employer may offer a few different plans to choose from. The plans may vary in cost due to premiums, deductible and out-of-pocket expense. That is why it's important to consider keeping a job when you need dialysis.
Medical coverage that you purchase directly from an insurance company is called an individual policy. You may decide to purchase insurance on your own if your employer does not offer coverage or you do not like the coverage they offer. These policies also vary in cost depending on the plan you choose.
Medicare is insurance through the federal government. Being an individual with end stage renal disease (ESRD), you may be eligible for Medicare. Medicare has three main parts: A, B and D. Part A helps with inpatient costs such as hospital stays and has no premium. Part B pays for outpatient care such as dialysis and doctor/specialist visits. Part B does have a premium. Part D helps pay for prescription coverage. Part D also has a premium. Medicare part B will only cover 80 percent of the cost of your dialysis. Your social worker and insurance counselor will educate you on other options such as Medicare supplements, Medicaid or other programs available in your area. To see if you qualify for Medicare, please speak with your dialysis social worker or insurance counselor. For additional information on options that may be available to you, utilize Medicare.gov.
Your DaVita social worker and insurance counselor are people who can help review your insurance and payment options. They will ensure your questions are answered so you can make an informed decision regarding your healthcare coverage.[i]
This site is for informational purposes only and is not intended to be a substitute for medical advice from a physician.
Please check with a physician if you need a diagnosis and/or for treatments as well as information regarding your specific condition. If you are experiencing urgent medical conditions, call 9-1-1