Does Health Insurance Cover Dialysis?

The kidneys play a critical role in a person’s health and well-being. They are responsible for eliminating waste and excessive amounts of minerals and water. Unfortunately, however, the kidneys – like any other part of the body – can become impaired. They can be damaged by illnesses or injuries, which can limit their ability to function properly. They can also completely fail, in which case they are completely unable to perform their intended functions.

Those who are diagnosed with kidney damage or failure are considered critically ill. If the kidneys cannot function the way they are supposed to, excessive levels of minerals, water, and other types of waste can buildup in the bloodstream. Over time (usually, that length of time is very short), the buildup of waste, minerals, and water can become extreme, putting the life of the individual in jeopardy; therefore, individuals who are afflicted with kidney damage or failure can perish.

What is Dialysis?

Patients that are diagnosed with kidney damage or failure require immediate medical care. The central part of their care will include dialysis treatment. Dialysis, also known as renal replacement therapy (RRT), replaces the function of the kidneys.

There are three main types of dialysis, including:

• Intermittent hemodialysis
• Peritoneal dialysis
• Continuous rental replacement therapies

The type of treatment that an individual will require depends on his or her specific condition; however, all three forms of treatment involve artificially recreating the function of the kidneys with specialized tools. In doing so, waste is removed from the bloodstream. Without dialysis, those who are suffering from kidney damage or renal failure, would eventually fall into a coma and ultimately die.

Needless to say, dialysis is a life-saving treatment.

Dialysis and Health Insurance

The cost of dialysis can be exorbitant. Fortunately, however, health insurance plans, as well as Medicare and Medicaid, do cover some, of not all, of the costs of this type of treatment.

For those patients who have health insurance, typically, the only out-of-pocket expenses that are associated with dialysis treatment are their deductible and coinsurance costs. The same is true for those who have healthcare coverage through Medicare. For example, if a patient has Medicare, he or she would have to pay the $150 deductible, as well as 20% coinsurance. However, many patients who are covered by Medicare have secondary health insurance, too, which helps to cover those out-of-pocket costs. Medicaid can also help to cover part of the cost that is associated dialysis treatment, too.

How to Find Out if Treatment is Covered

As with any other type of medical services you require, if you have been diagnosed with kidney damage or renal failure and require dialysis, it’s important that you contact your insurance company. Speak to a representative to find out exactly how your specific plan will cover treatment. As mentioned, most insurance plans – including employer-sponsored, private Marketplace plans, and Medicare – will cover at least a portion of the treatment. With that said, however, the extent to which your policy will cover your treatment depends on a variety of factors, including:

• The stage of renal failure you are in
• The type of plan you have
• Whether or not you are eligible for Medicare

It is likely that you will incur some out-of-pocket expenses, regardless of how much your healthcare plan covers dialysis treatment. As mentioned above, you will have to meet your deductible before your insurance coverage kicks in; additionally, you may have to pay a copay for each treatment.

If you are eligible for Medicare and you carry private or employer-sponsored health insurance, they may work together to cover all of the expenses. For instance, if your private insurance may cover the portion of treatment that Medicare doesn’t cover.

The Bottom Line

Dialysis is considered a medically necessary treatment for those who are suffering from any degree of renal failure. As such, health insurance will cover at least a portion of this type of treatment. As always, contact your carrier to find out the specifics of your policy. If you do not have health insurance and you are eligible for Medicare, this type of healthcare will cover a portion of your treatment.

If you currently carry health insurance – whether a private policy or through Medicare – and the coverage you have does not offer enough assistance for dialysis, speak to a reputable insurance agent. Together, you can discuss the different options that are available for you in regard to finding a health insurance plan that will provide the best coverage for the life-saving dialysis treatment that you require.

If you are diagnosed with kidney damage or liver failure – no matter the extent – dialysis treatment is an absolute must. The cost of treatment can be exorbitant, if you don’t have health insurance coverage; however, take comfort in knowing that there are options available that can offset all, if not most of the cost.