By Chad Lennox
Dialysis patients are unique in that no matter what their age, they are eligible to qualify for Medicare under the program’s end-stage renal disease (ESRD) benefit. Fortunately, Medicare covers the majority of patients’ medical costs—80 percent. However, patients are left to cover the remaining 20 percent, which includes costs such as medical deductibles and co-pays.
Most patients have access to some other type of insurance—referred to as secondary insurance—to help them cover these expenses, which can be quite significant when considering the costs of regular doctors’ visits, prescription drugs and other necessary treatments. This type of secondary insurance could fall under a private pay plan, or it could be provided through Medicaid assistance.
For ESRD patients age 65 and older who do not have access to secondary insurance, Medicare allows them to purchase Medigap, a supplemental insurance to assist them with covering their out-of-pocket expenses. Medigap is so named because it was created to cover the “gap” between what Medicare pays and the total cost of the service.
For many patients, having the ability to access Medigap coverage can mean the difference between comfortably paying their medical bills or having to choose between paying their healthcare bills and other daily living expenses—a choice no one should have to face.
Unfortunately, a “gap” that exists with Medigap policy is that federal law does not allow Medicare beneficiaries under age 65 to purchase it. To resolve this problem, 31 states in the country have voted to enact statewide legislation providing ESRD and disabled patients under age 65 with this opportunity. In states ranging from Washington to Florida, patients as well as taxpayers are seeing the benefit of this expanded access to care.
By helping patients avoid having to spend their personal assets and turn to Medicaid for support, enhanced Medigap policies are saving millions of dollars for state Medicaid programs. For example, as a result of passing Medigap legislation this year, the state of Georgia is estimated to save $20 million over the next five years.
Having the ability to purchase a Medigap policy is an issue that has greatly resonated with dialysis patients. With some patients who are on the verge of needing government support in order to pay their medical bills, it is very important to them to be able to have an option for maintaining their independence. With our members, for example, Dialysis Patient Citizens (DPC) members have turned out in great numbers to support statewide Medigap legislation in several states around the country.
Our patient members have traveled to their state capitols to testify before committees, they have spoken with their state legislators, and they have even written to their local newspapers about the benefit of this coverage option to the dialysis patient community.
For example, DPC member and dialysis patient Eric Edwards attended a Georgia Senate committee hearing this February to help show support for Medigap legislation and its benefit for younger ESRD patients. Like many other patients in the state, due to his expensive co-pays, Edwards is sometimes forced to put off visiting his physician—and for some patients, such a delay in treatment can lead to complications in care.
In Georgia, Eric’s and other DPC members’ voices were heard when the state legislature voted to pass the bill this year with overwhelming support. In addition, the Tennessee legislature passed a similar Medigap bill this year with tremendous support.
Dialysis patients are not stopping there, however. DPC and our members are continuing to look at other states where Medigap access would benefit patients under age 65. Our belief is that every patient should have the ability to access the medical care they need without having to bankrupt themselves and their families, and we will continue our work to help all patients have the ability to purchase affordable Medigap policies.
For more information on Medigap, where it is offered and how you can get involved with advocating for patients’ expanded access, please visit www.dialysispatients.org. RBT
Chad Lennox is the executive director of the nonprofit, 23,000-member Dialysis Patient Citizens, which works to improve the quality of life for all dialysis patients through education and advocacy. He can be reached at firstname.lastname@example.org.