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Insurance 101 for People on Dialysis

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

Question: How is dialysis paid for?

Answer: Dialysis is paid for by medical insurance provided by your Employer Group Health Plan (EGHP), retirement plan, Medicare or Medicaid. Depending on your situation, other government insurance options may be available.

Financial assistance can also be provided when your out-of-pocket costs are not covered by Medicare and/or your medical insurance. Ask a DaVita insurance specialist about non-DaVita programs that can help pay for your dialysis by calling 1-855-534-2597 or visiting DaVita.com/IMT.

Question: How often do I need to update my insurance benefits?

Answer: Once a year is typical. However, if you experience any life changes, you should review your plan right away.

Question: I have Medicare Part B to pay for my dialysis treatment. Why do I need other insurance?

Answer: It’s important to be fully covered when you need dialysis. If you have Part B—clinical outpatient services coverage—it pays only 80 percent, leaving you with a 20 percent coinsurance to pay. Additional insurance can help pay the rest of treatment costs and provide payment for medical specialists and medications.

Question: I have insurance through my employer. Do I need Medicare?

Answer: This would depend on how your EGHP is set up. Many people on dialysis defer enrollment into Medicare because there is no financial benefit to enrolling. For example, if you are covered under a plan that pays 100 percent, with no out-of-pocket expense, then you may consider deferring enrollment during the EGHP coverage period. On the other hand, if you are covered under a plan with significant out-of-pocket costs, you may want to enroll in Medicare.

Question: Who pays for the cost of a kidney transplant?

Answer: If you are eligible to receive a kidney transplant, your EGHP may cover it (and Medicare would be secondary). If your plan does not cover a transplant, Medicare will pay 100 percent of hospital charges and 80 percent of Medicare’s allowable rate for doctors’ fees associated with outpatient care. Medicare will also pay for a living kidney donor to be evaluated, but your donor may have costs that aren’t covered (e.g., travel, time off of work).

Want to know more about insurance?

Everyone’s insurance plan and health needs are unique. DaVita insurance specialists and social workers can review your information and help answer questions you may have. Contact them by calling 1-855-534-2597 or visiting DaVita.com/IMT.

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