Financial Planning for Chronic Kidney Disease Patients

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Over 1 in 7 U.S. adults, or an estimated 37 million Americans, have chronic kidney disease. Treating chronic kidney disease, particularly end-stage renal disease, incurs substantial costs. In 2021, Medicare spending for older users diagnosed with chronic kidney disease reached $76.8 billion, nearly a quarter of all spending for that age group, while expenditures for those with end-stage renal disease totaled $52.8 billion after inflation adjustment.

Resources are available to help you manage the financial implications of chronic kidney disease treatments, ranging from government programs like Medicare and Medicaid to financial assistance from nonprofit organizations. Tap into these resources and engage in strategic financial planning to save money while ensuring you receive the necessary treatment.

Costs of Chronic Kidney Disease Treatments

The treatment of chronic kidney disease can involve significant costs. The main costs for its treatments may include dialysis, medications and additional expenses such as potential complications, dietary supplements and home health services. Recognizing these costs helps you prepare your finances effectively, allocate resources wisely and better anticipate out-of-pocket expenses. Secure adequate health insurance and utilize your coverage effectively to guarantee access to necessary treatments without facing overwhelming costs.

Dialysis Treatment Costs

Dialysis is a treatment for filtering blood when chronic kidney disease prevents the kidneys from functioning effectively. There are two main types: hemodialysis, which externally filters blood through a machine and peritoneal dialysis, an internal process using the abdomen's lining. Dialysis is required when kidney function drops to 10% to 15%. A kidney specialist will monitor your condition to determine the need for dialysis. Medicare covers dialysis treatments under Part B, typically paying 80% of the approved amount for both in-center and home services, but eligibility and coverage can vary.

Hemodialysis

Hemodialysis, a widely used treatment for chronic kidney disease, works by circulating a patient's blood through a machine to filter out waste, much like a kidney would. In 2021, the average cost for Medicare beneficiaries undergoing hemodialysis, adjusted for inflation, was $99,325 annually. Hemodialysis can be administered in a dialysis center or at home, with each option offering benefits and drawbacks. Consult your health care provider and discuss these options to determine the most suitable and cost-effective choice for your situation.

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Dialysis Center
Home Hemodialysis

Professional Assistance

Health care professionals set up and assist with the dialysis machine, and a support team is available.

You will need to manage the dialysis process yourself or, with the help of a caregiver, with periodic visits to a doctor. You'll also still need to visit your doctor monthly.

Treatment Frequency

Standard in-center hemodialysis is typically three times a week or three nights a week if you choose nocturnal dialysis.

Its more intensive, it is typically three to seven times per week, with each session lasting 2 to 10 hours.

Session Duration

Standard sessions can last about 4 hours or longer, while nocturnal sessions are typically done while you sleep.

It varies, but can last between 2 and 10 hours.

Additional Expenses

It includes transportation and possibly increased costs for nocturnal dialysis.

It includes increased electricity and water bills, device installation and maintenance expenses.

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WHERE TO FIND A DIALYSIS CENTER

Consult your doctor, nurse or social worker to find a convenient dialysis center. Under Medicare regulations, you have the right to select your treatment location. Consider using resources like Dialysis Facility Compare to evaluate centers based on quality metrics.

Peritoneal Dialysis

Peritoneal dialysis uses the abdomen's lining and a cleansing fluid to internally purify the blood, generally costing less than hemodialysis. There are two main types, continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), which differ in exchange schedules and the use of a machine for APD. Both types offer the flexibility to be performed in any clean, private setting, such as at home, work or even when traveling.

Costs vary based on several factors, but peritoneal dialysis could be more financially viable than hemodialysis. In 2021, the yearly costs for patients treated with peritoneal dialysis, after adjusting for inflation,, averaged $82,298.

Dialysis Medications

Individuals undergoing dialysis require 10 to 12 different drugs to manage renal, hematological, neurological, muscle and gastrointestinal issues. Medicare Part D can reduce the cost of these prescription drugs, although you're still responsible for its out-of-pocket costs. The average out-of-pocket costs for Medicare Part D covered chronic kidney disease drugs were $775 in 2021. The drug costs patients pay depend on several factors, including prescription, income and their drug coverage.

Several resources are available to assist with medication expenses. For instance, those with Part D coverage who have limited income and resources may qualify for Part D extra help. Beneficiaries receiving Medicare’s low-income subsidy paid only 1%-2% out-of-pocket, while those without the subsidy faced 28%-32% costs.

Additional Costs

When managing kidney disease, consider various additional costs beyond standard treatment expenses. Incorporating these additional costs into a comprehensive financial plan helps form a more realistic and sustainable budget. These may include:

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    Transportation

    Regular trips to and from treatment centers can significantly add to expenses.

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    Lab Testing

    Ongoing lab tests to monitor disease progression and treatment response can increase the overall treatment cost.

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    Unforeseen Complications

    Sudden health issues requiring additional medications or treatments can unexpectedly increase costs.

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    Home Modifications

    Certain modifications might be needed for the treatment setup for those opting for home-based dialysis, like peritoneal dialysis or home hemodialysis.

Paying for Chronic Kidney Disease Treatments

In the U.S., Medicare is a primary source for dialysis funding, but it requires a 20% copay or coinsurance under Medicare Part B. Private insurance often involves considerable coinsurance, too. These out-of-pocket costs, combined with work limitations due to frequent hemodialysis and fatigue from end-stage kidney disease, make treatment financially challenging for many. Consider supplementing your coverage with Medicaid, family and friend support.

Insurance Coverage

Navigating treatment costs can be facilitated by leveraging insurance plans. Medicaid supports low-income individuals, while Medicare covers those 65 and over or with certain disabilities. Supplemental insurance policies can bridge gaps in Medicare and other insurance. Private Health Insuranceand a offers broader coverage and diverse cost-sharing options. Each varies in approval criteria, coverage scope, out-of-pocket expenses and application procedures. Familiarize yourself with how these insurance works to help you maximize coverage.

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    Medicare

    If you have end-stage renal disease, you're eligible for Medicare regardless of age, but specific criteria must be met. You need to enroll in Medicare Part A and B for comprehensive dialysis and kidney transplant treatments. Alternatively, you can join a Medicare Advantage Plan or Medicare Part C, which bundles Parts A, B and often D into one plan offered by private companies approved by Medicare. These plans may include additional benefits useful in managing kidney disease, such as coverage for prescription drugs, routine vision or dental care and wellness programs.

    Coverage for a kidney transplant begins the month you're admitted to a Medicare-certified hospital for related services if the transplant is within that month or the following two. Enroll in Medicare as soon as eligible to secure coverage for transplant medications. Be aware that some costs remain uncovered by Medicare. You're responsible for coinsurance amounts unless you have Medicaid or supplemental insurance.

    Sign up for Part A and B through your local Social Security office or by calling Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. If you're eligible due to ESRD and delayed enrollment, coverage may be activated retroactively up to 12 months from the application month. A dialysis billing manager can guide you through the enrollment following standard Medicare criteria.

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    Medicaid

    Medicaid covers part of the dialysis costs, with eligibility varying state-by-state, mainly based on income. Not all additional services, such as transportation, may be covered. Visit the Medicaid website or contact your state's Medicaid office to apply or enroll. Ensure you know the eligibility criteria and have all the required documents for a streamlined application. Medicaid might offer retroactive coverage for expenses incurred up to three months before applying.

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    Supplemental Insurance

    Supplemental insurance helps cover costs not included in your primary plan, such as copays and deductibles, which is particularly beneficial for dialysis patients facing long-term treatment expenses. For those with Medicare, a supplemental Medigap plan is worth considering. Medigapcovers costs that Medicare does not, including deductibles and coinsurance. However, consider the premium costs, which are payable even when services aren't used.

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    Private Health Insurance

    Private health insurance, typically through employers, may cover dialysis but often at 3 to 10 times the cost of Medicare. Plan details and limits, including potential lifetime caps, vary. For those eligible for Medicare with an Employer Group Health Plan (EGHP), the EGHP is primary for the first 30 months and then becomes secondary to Medicare.

    Be mindful of coinsurance requirements, often up to 40%, which you'll need to pay. When choosing a plan, examine its limitations and consider lifetime maximums and the benefits of Medigap coverage. Evaluate plans against your health care needs and financial situation to ensure you find affordable health insurance that effectively meets your needs.

Alternative Financing Options

Beyond insurance coverage, Health Savings Accounts (HSAs) and crowdfunding can also aid in covering out-of-pocket expenses associated with dialysis treatment. Many states also offer assistance programs for patients with kidney disease. Check with your state's health department for available resources.

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    Health Savings Account

    HSAs are tax-advantaged accounts for individuals with high-deductible health plans. They allow pre-tax contributions for qualified medical expenses, including dialysis costs. Eligibility requires enrollment in a High Deductible Health Plan (HDHP), no other health coverage, not being on Medicare and not being claimed as a dependent.

    To open an HSA, select a trustee like a bank or insurer and note the IRS's annual contribution limits. HSAs offer tax benefits and more control over health care finances but necessitate careful management due to the associated high deductibles. Thoroughly evaluate all factors and possible outcomes before opting for an HSA.

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    Crowdfunding

    Crowdfunding is a practical approach for dialysis patients to gather funds for treatment costs. Platforms like GoFundMe or Kickstarter enable you to share your stories and solicit financial support. This approach is most effective if you have a robust and empathetic community. Detail your medical costs and potential expenditures to maintain transparency and build trust among potential donors.

Financial Assistance for Chronic Kidney Disease Treatments

Aside from government programs, various financial resources from nonprofit organizations are accessible to help patients with chronic kidney disease manage treatment costs. Submit complete applications with all necessary documents. Continuously check for new programs and updates, as available resources can change, to enhance approval odds.

Nonprofit Organizations

Nonprofit organizations also offer financial assistance to individuals struggling with chronic kidney disease. They can assist with funding treatments, providing educational services and establishing support networks for patients with kidney disease.

  • American Kidney Fund (AKF): AKF offers kidney patients several forms of financial assistance. It provides grants to help cover the costs of health insurance premiums, transportation to treatment, medications and kidney donor expenses. The fund also offers disaster relief for dialysis patients affected by natural disasters.
  • National Kidney Foundation: While primarily focused on education, advocacy and research, the National Kidney Foundation sometimes provides emergency financial assistance through local offices. They also offer resources and guidance on accessing and applying for financial support.
  • Renal Support Network (RSN): RSN primarily offers emotional and practical support through programs that empower patients. While not directly providing financial assistance, it offers resources and guidance on managing the costs associated with treatment and connects patients with other assistance programs and support networks.

Pharmaceutical Assistance Resources

Pharmaceutical assistance programs can help reduce medication costs for chronic kidney disease patients. Accessing multiple sources of assistance can substantially lower your out-of-pocket expenses for dialysis medications. Here are some resources to help you connect with pharmaceutical assistance programs for chronic kidney medication costs:

  • BenefitsCheckUp: A free service provided by the National Council on Aging, BenefitsCheckUp helps you find programs to assist with medications and other health care expenses. It includes a comprehensive search of federal, state and private benefits programs tailored to the individual's health needs.
  • Medicine Assistance Tool: This tool, created by the Pharmaceutical Research and Manufacturers of America (PhRMA), connects patients to resources offered by various biopharmaceutical industry programs. It helps you find assistance with accessing and affording medications, including those for chronic kidney disease.
  • RxAssist: RxAssist offers a comprehensive database of Patient Assistance Programs established by pharmaceutical companies. These programs often provide medications for free or at a lower cost to qualifying individuals, including those requiring treatments for chronic kidney disease.
  • State Pharmaceutical Assistance Programs (SPAPs): Many states offer their own pharmaceutical assistance programs to help residents afford the prescription medications they need. These programs may provide additional support or work alongside Medicare Part D and some may have specific provisions or programs for chronic kidney disease treatments.

Additional Resources

We've gathered a few additional resources that can provide extra help navigating the financial landscape of chronic kidney disease and dialysis treatment.

  • American Association of Kidney Patients (AAKP): Their mission is to improve kidney patients' lives and long-term outcomes through education, advocacy, patient engagement and fostering patient communities. They have resources focused on the financial aspects of treatment.
  • Dialysis Patient Citizens (DPC): Provides educational materials and hosts educational conferences to empower patients and improve kidney disease awareness. Their resources can guide patients in navigating the financial complexities of kidney disease treatments.
  • Kidney Care Partners: An alliance of patient advocates, dialysis professionals, care providers and manufacturers committed to improving the quality of life for those with kidney disease. They offer comprehensive resources for understanding and managing the costs associated with dialysis.
  • National Institute of Diabetes and Digestive and Kidney Diseases: Offers comprehensive research, educational materials and clinical information to help understand and manage kidney diseases.
  • NeedyMeds: Offers information on available patient assistance programs and helps individuals apply for aid.
  • NephCure Kidney International: They offer information on financial assistance programs, insurance counseling and other resources to help patients and their families afford necessary treatments.
  • Rx Outreach: A nonprofit pharmacy committed to making affordable medications accessible to underserved communities.
  • State Health Insurance Assistance Programs (SHIPs): Provides no-charge, extensive, one-on-one insurance counseling and aid to Medicare beneficiaries and their support network, including families, friends and caregivers.
  • United States Renal Data System: Provides detailed reports and statistics on kidney disease in the U.S., aiding in understanding trends, treatments and patient outcomes.

About Nathan Paulus

Nathan Paulus headshot

Nathan Paulus is the Head of Content Marketing at MoneyGeek, with nearly 10 years of experience researching and creating content related to personal finance and financial literacy.

Paulus has a bachelor's degree in English from the University of St. Thomas, Houston. He enjoys helping people from all walks of life build stronger financial foundations.

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