Financial Planning for Chronic Kidney Disease Patients

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, 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 necessary treatment.

Chronic kidney disease treatment comes with high costs. Major expenses include dialysis, medications and additional costs like managing complications, dietary supplements and home health services. 

Being aware of these costs helps you budget and prepare for any out-of-pocket payments. Adequate health insurance coverage ensures access to necessary treatments without overwhelming costs.

Dialysis filters blood when chronic kidney disease prevents kidneys from functioning effectively. Two main types exist: 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, usually paying 80% of the approved amount for both in-center and home services, but eligibility and coverage can vary.

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 to determine the most suitable and cost-effective choice for your situation.

Peritoneal dialysis uses the abdomen's lining and a cleansing fluid to internally purify the blood, generally costing less than hemodialysis. Two main types exist: 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 many factors, but peritoneal dialysis could be more financially viable than hemodialysis. In 2021, yearly costs for patients treated with peritoneal dialysis, after adjusting for inflation, averaged $82,298

Individuals undergoing dialysis require 10 to 12 different drugs to manage renal, hematological, neurological, muscle and gastrointestinal issues. Medicare Part D can reduce prescription drug costs, although you're still responsible for its out-of-pocket costs. Average out-of-pocket costs for Medicare Part D covered chronic kidney disease drugs were $775 in 2021. Drug costs depend on several factors, including prescription type, income and 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% to 2% out-of-pocket, while those without the subsidy paid 28% to 32%.

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:

In the U.S., Medicare is the main source of funding for dialysis, but patients are responsible for a 20% copay or coinsurance under Medicare Part B. Private insurance plans can also come with high coinsurance rates.

These out-of-pocket costs, along with reduced work hours caused by frequent hemodialysis and fatigue from end-stage kidney disease, can make treatment hard to afford. You may want to look into extra help through Medicaid or support from family and friends.

Insurance plans help you navigate treatment costs. 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 insurance offers broader coverage and diverse cost-sharing options. Each varies in approval criteria, coverage scope, out-of-pocket expenses and application procedures. Understanding how these insurance options work helps you maximize coverage.

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.

Beyond 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 improve approval odds.

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 programs can help lower medication costs for people with chronic kidney disease. Using more than one type of assistance can greatly cut your out-of-pocket expenses for dialysis medicines. The following resources can help you find programs that offer support with 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 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.