Two patient advocates in Oregon, Troyce Crucchiola, a transplant recipient, and Patty Danielson, a dialysis patient, stood up for all end-stage renal disease (ESRD) patients in the state of Oregon to declare that insurance companies should not be allowed to force ESRD patients into Medicare prematurely. They asserted that patients should have the right to make insurance decisions that best meets their needs, and shared their personal experiences with insurance coverage, healthcare, and ESRD.
Troyce attended a private meeting, along with provider and patient stakeholders, with the Oregon Insurance Commissioner Laura Cali. Patty spoke at a public forum held by the Insurance Department a couple of weeks later. Their efforts paid off. Yesterday, the Oregon Insurance Department issued a final decision stating that health insurers could not design benefits that coerce patients into enrolling in Medicare. The National Kidney Foundation (NKF) thanks these advocates for taking the lead to protect all ESRD patients in the state of Oregon from discriminatory insurance practices.
While changes in law through the Affordable Care Act (ACA) have made it easier for kidney patients to obtain private health insurance, some ambiguity remains pertaining to how insurers can control costs and what constitutes discrimination in health insurance. NKF asserts that any benefit design or cost-shifting that singles out individuals with a chronic condition is discrimination and is prohibited under the ACA. In Oregon, one health insurance company in particular has a benefit design that directed beneficiaries once they reach end-stage renal disease (ESRD) to enroll in Medicare within three months. If the beneficiary remained on the plan, the provider will pay 125% of the Medicare rate, rather than the negotiated rate, and the patients will have to pay the remaining charges, which the plan stated would not count towards the patients out -of-pocket maximums. NKF believes that patients should have the choice whether or not to enroll in Medicare. Additionally, there are laws in place to protect patients from having to pay more out-of-pocket to maintain that right. Patients covered by an employer group health plan can maintain their primary coverage for at least 30 months before the plan is permitted to pay secondary to Medicare. For individual health insurance marketplace plans, the ACA is supposed to protect patients wishing to maintain those plans and forgo Medicare.
While we are pleased with our success in Oregon, we know our work is not over. Today, NKF submitted comments to the U.S. Department of Health and Human Services, Office of Civil Rights, asking for greater clarity and protection for kidney patients in health insurance and health systems policies across the U.S. A national process for oversight and reporting of discriminatory acts will help ensure that everyone clearly understands that patients with chronic conditions, including ESRD, should have the same access to affordable health care as the rest of the population. You can read our comments here.
Learn more about your insurance options and rights as an ESRD patient by checking out NKF’s insurance resources here.