We’re seeing an alarming new trend of End Stage Renal Disease (ESRD) patients facing discriminatory policies by insurers. In several states, the kidney patient community has identified insurance plans discriminating against ESRD patients through several methods. The policies mislead consumers into believing that Medicare is an added benefit of their insurance, without disclosing downsides, to convince consumers to sign up for Medicare. Policies also penalize consumers who do not enroll by using non-negotiated set payments rates for dialysis providers and subjecting patients to the remainder of the charges billed by the dialysis provider. These costs are not applied to the patient’s out-of-pocket maximum.

For individual marketplace plans, ESRD patients who enroll in Medicare will lose tax credits and subsidies. Additionally, Medicare can become primary to individual plans after three months, which limits most, if not all, of the benefits patients would have under the marketplace plan. While individuals are eligible to enroll in Medicare due to ESRD, regardless of age, they are not required to do so. In August, after requests by the National Kidney Foundation (NKF) and others in the kidney community, the Centers for Medicare & Medicaid Services (CMS) clarified this right for ESRD patients in its frequently asked questions document, which can be found here.

These developments in states such as Oregon, Washington, and Idaho, have led NKF to take action to protect ESRD patients choice in insurance coverage. NKF has addressed these discriminatory policies with the state insurance commissions to combat these misleading policies.

NKF has also offered comments to CMS and the Department of Health and Human Services (HHS) addressing these, and other, issues. In comments to the Draft 2017 Letter to Issuers and the Patient Protection and Affordable Care Act: HHS Notice of Benefit and Payment Parameters for 2017, NKF suggested several policy alterations to ensure private health insurance plans cover the services and health care providers that kidney patients need. NKF’s proposals include:

• clarification that insurers are not able to terminate coverage, limit benefits, or use non-negotiated rates subjecting patients to balance billing charges not included towards out of pockets maximums
• further protection against cost-shifting of prescription drugs
• supporting HHS efforts to institute a drive time and distance standard to dialysis facilities
• urging HHS to finalize standards to ensure an adequate number of nephrologists, dialysis facilities, and transplant care centers are included in the plans provider network
• urging continuity of care provisions to ensure patients do not unexpectedly have to change healthcare providers
• requiring health insurance companies to accept third-party payments for premium assistance from non-profit financial assistance organizations that existed prior to ACA, and have met certain conditions.

Should you become aware of aware of any issues similar to those being faced by kidney patients, please contact us at nkfadvocacy@kidney.org so that we may help combat these discriminatory policies everywhere.