Financial Help for Treatment of Kidney Failure
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If you have permanent kidney failure, you may be worried about paying for the expensive treatments you need.
In 1972, Congress passed legislation making people of any age with permanent kidney failure eligible for Medicare, a program that helps people over 65 and people with disabilities pay for medical care, usually up to 80 percent. Other public and private resources can help with the remaining 20 percent. Your dialysis or transplant center has a social worker who can help you locate and apply for financial assistance.
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Medicare
Medicare is a federally administered health insurance program for people 65 and older and people of any age with permanent kidney failure. To qualify for Medicare on the basis of kidney failure, you must
 need regular dialysis
or
have had a kidney transplant
and you must
have paid into Social Security through your employer
or
worked under the Railroad Retirement Board, or as a government employee (or be the child or spouse of someone who has)
or
you must already be receiving Social Security, Railroad Retirement, or Office of Personnel Management benefits.
You can enroll for Medicare at your local Social Security office (check the blue pages in your phone directory to locate the office).
Medicare has two parts: Part A (hospital insurance) and Part B (medical insurance). Part B covers doctors' services, outpatient hospital services, and many other health services and supplies. While Medicare Part A has no premiums, Part B requires you to pay premiums, deductibles, and coinsurance. Part B is voluntary. Most of the services and supplies needed by people with permanent kidney failure are covered by Medicare Part B.
You will apply for Medicare when you start dialysis treatments. Your Medicare benefits then begin the third month after the month your course of regular dialysis treatments begins. For example, if you begin receiving regular dialysis treatments in July, your Medicare coverage would start on October 1. Coverage can begin earlier if you take self-care dialysis training (for home hemodialysis or peritoneal dialysis) before the third month or have a transplant within the first 3 months.
If you're covered by a group health plan, Medicare is a secondary payer during a 30-month coordination period. Your group health plan pays at its regular level for this period. Since you usually can't get Medicare in the first 3 months, your group health plan is the only payer for health services. In the third month, Medicare begins to cover only that portion of your health services that isn't covered by your group health plan. Medicare then becomes the primary payer for your health insurance claims at the end of the 30-month period.
You may wish to wait to enroll in Medicare Part A and Part B until the end of the 30-month coordination period if your group health plan will pay for all of your health care expenses. In doing so, you'll avoid paying the Medicare Part B premium.
Enrolling in Medicare Parts A and B could help pay a yearly deductible or coinsurance payment required by some group health plans.
Contact your local Social Security office or call the nationwide toll-free number at 1–800–772–1213 if you want to apply for Medicare. Often, the social worker at your hospital or dialysis center will help you apply.
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Private Insurance
Private insurance frequently pays for the entire cost of treatment. Or it may pay for the 20 percent that Medicare doesn't cover. Private insurance may also pay for your prescription drugs. Read your private health insurance policy carefully to make sure it covers kidney failure. Talk with your insurance agent or company benefits counselor if you have any questions about your benefits.
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Medicaid
Medicaid is a state program. Your income must be below a certain level
to receive Medicaid funds. If you aren't eligible for Medicare, Medicaid
may pay for your treatments. In some states, it pays the 20 percent that
Medicare doesn't cover. It may also pay for some of your medicines. To
apply for Medicaid, talk with your social worker or contact your local
department of human services or social services.
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State Children's Health Insurance Program
The U.S. Department of Health and Human Services has established the
State Children's Health Insurance Program (SCHIP) to help children without health insurance.
SCHIP provides health coverage for children whose families earn too much to qualify for
Medicaid but too little to afford private health insurance. Consumers can
obtain information about the program by calling toll-free 1-877-KIDS-NOW (543-7669),
or by checking www.insurekidsnow.gov.
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Department of Veterans Affairs (VA) Benefits
If you're a veteran, the VA can help pay for treatment or provide other
benefits. Contact your local VA office for more information, or call 1–800–827–1000
to reach the national office. If you're retired from the military, you
may also call the Department of Defense at 1–800–538–9552.
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Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)
These benefits from the Social Security Administration help you with the costs of daily living. To receive Social Security Disability Insurance (SSDI), you must be unable to work and have earned the required number of work credits.
You can receive Supplemental Security Income (SSI) if you don't own much and have a low income. People who get SSI usually get food stamps and Medicaid, too. To find out if you qualify for SSDI and SSI, talk to your social worker or call your local Social Security office or the nationwide number, 1–800–772–1213.
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Patient Assistance Programs From Prescription Drug Companies
Medicare pays for erythropoietin to treat anemia in kidney failure and
for immunosuppressants to prevent rejection of a transplanted kidney.
But other self-administered drugs that you need may not be covered by
Medicare. If you have trouble paying for all the medications your doctor
prescribes, you may qualify for assistance from private programs. Most
drug manufacturers have patient assistance programs giving discounts to
patients who can show that they can't afford the cost of their prescribed
medications.
The Partnership for Prescription Assistance provides a website that directs patients, caregivers, and doctors to more than 275 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies. The website features an application wizard that helps you determine which programs might be available to you. The web address is www.pparx.org.
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Additional Patient Assistance Programs
The United Network for Organ Sharing (UNOS) offers a website called Transplant Living,
which includes a section on financing a transplant. The web address is www.transplantliving.org/beforethetransplant/finance/finance.aspx.
For more information about UNOS, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
booklet Treatment Methods for Kidney Failure: Kidney Transplantation.
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Additional Organizations That Can Help
Several groups offer information about sources of financial help for patients with kidney disease in the United States. You may wish to contact one of the following:
American Association of Kidney Patients
3505 East Frontage Road
Suite 315
Tampa, FL 33607
Phone: 1–800–749–2257
Fax: 813–636–8122
Email: info@aakp.org
Internet: www.aakp.org
American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1–800–638–8299 or 301–881–3052
Fax: 301–881–0898
Email: helpline@kidneyfund.org
Internet: www.kidneyfund.org
Life Options Rehabilitation Program
c/o Medical Education Institute, Inc.
414 D'Onofrio Drive
Suite 200
Madison, WI 53719
Phone: 1–800–468–7777 or 608–232–2333
Email: lifeoptions@MEIresearch.org
Internet: www.lifeoptions.org
www.kidneyschool.org
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 1–800–622–9010 or 212–889–2210
Fax: 212–689–9261
Internet: www.kidney.org
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Additional Reading
If you would like to learn more about financial assistance for kidney failure treatments, you may be interested in reading these publications:
Medicare Coverage of Kidney Dialysis and Kidney Transplant Services
Publication Number CMS-10128
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244–1850
Phone: 1–800–MEDICARE (1–800–633–4227)
Internet: www.medicare.gov
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About the Kidney Failure Series
The NIDDK Kidney Failure
Series includes six booklets and seven fact sheets that can help
you learn more about treatment methods for kidney failure, complications
of dialysis, financial help for the treatment of kidney failure, and eating
right on hemodialysis. For free single printed copies of this series,
please contact the National Kidney and
Urologic Diseases Information Clearinghouse.
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892–3580
Phone: 1–800–891–5390
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nkudic@info.niddk.nih.gov
Internet: www.kidney.niddk.nih.gov
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.
Publications produced by the clearinghouse are carefully reviewed by both NIDDK
scientists and outside experts. This publication was reviewed by Margaret
Jefferson, Eve Fisher, Jackie Sheridan, and Betty Burrier, Centers for
Medicare & Medicaid Services.
This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
NIH Publication No. 07–4765
August 2007
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