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It’s Time to Open Medicare Advantage Enrollment to Dialysis Patients

2024-03-28T21:05:04-04:00March 10th, 2016|Categories: Costs for Treatment, eNews, Fact Sheet|

In the wake of recent action by CMS to maintain Medicare Advantage funding, the time is ripe to follow up on a recommendation made by the Medicare Payment Advisory Commission 14 years ago: repeal the law prohibiting dialysis patients from enrolling in Medicare Advantage. The exclusion of end-stage renal disease (ESRD) patients from Part C deprives them of the opportunity to access two important benefits: care coordination by a single, accountable entity; and maximum out-of-pocket limitations. ESRD Patients Lack Access to Care Coordination, Resulting in Avoidable Complications As AHIP noted in a 2010 white paper, “health plans provide a life line” [...]

Dialysis Patients’ Guide to the Medicare ESRD Bundle

2024-03-28T21:05:06-04:00March 9th, 2016|Categories: Costs for Treatment, eNews, Fact Sheet|

Medicare is changing how it pays for dialysis, and this is expected to impact your care. These changes started in 2011 and will continue through 2016. This is a guide to what you need to know and what you can do to help ensure you continue to receive quality dialysis care during this transition period. HOW WAS DIALYSIS PAID FOR TRADITIONALLY? Dialysis treatments, injectable medications received in the clinic, laboratory tests and other items used to treat end stage renal disease (ESRD, also known as kidney failure) are paid for by Medicare Part B for most patients. However, before January [...]

Why DPC Supports Opening Medicare Advantage Enrollment to Dialysis Patients

2024-03-28T21:05:07-04:00March 8th, 2016|Categories: Costs for Treatment, Fact Sheet, The Kidney Citizen|

By Jackson Williams, Government Affairs Director for Dialysis Patient Citizens Would dialysis patients benefit from being allowed to enroll in Medicare managed care plans? Many health policy experts in Washington D.C. admire the leading integrated insurer/delivery systems such as Kaiser Permanente and Group Health Cooperative, and view them as models for transforming traditional Medicare. But outside of certain regions of the U.S., most American consumers remain skeptical of private health insurers. Managed care requires trading off retaining your choice of providers that traditional Medicare gives beneficiaries against a chance to receive other benefits. DPC does not advocate that ESRD patients [...]

Report Identifies Positive News on Kidney Disease in the US, Yet Challenges Remain

2024-03-28T21:05:51-04:00February 2nd, 2016|Categories: Costs for Treatment, Dialysis, Early Intervention, eNews, Kidney Transplant, Stages of Kidney Disease|

The annual data report from the United States Renal Data System (USRDS) reveals both positive and negative trends in kidney disease in the United States. Positive news includes fewer deaths among kidney patients and an increasing use of home dialysis treatments. Ongoing challenges include increasing medical costs for dialysis treatment and an overall increase in the size of the dialysis population. Highlights from the report include: Fewer deaths were reported among dialysis and kidney transplant patients in 2013, dropping by 28 percent and 40 percent, respectively, since 1996. Prevalence of end-stage kidney disease—the last stage of chronic kidney disease when the [...]

Financial Coverage for Peritoneal Dialysis

2024-03-28T21:06:52-04:00February 4th, 2013|Categories: Costs for Treatment, eNews, Peritoneal Dialysis|

There are several options to pay for your dialysis treatments including insurance through your employer or other private health plan, Medicare, Medicaid and through military health programs. The Medicare program was designed to be available to anyone who was born in the US, a permanent and legal resident for 5 years, or the spouse of an individual who paid Medicare taxes for at least 10 years.  People with end stage renal disease (ESRD) or those who needed a kidney transplant regardless of age (as long as they met the residency requirements) qualify for Medicare. Some individuals are considered dual eligible [...]

Medicare by the Letter

2024-03-28T21:07:12-04:00December 17th, 2012|Categories: Costs for Treatment, eNews|Tags: |

Part A Medicare part A is designed to help cover expenses for institutional care. These mean hospitals, skilled nursing facilities after a hospital stay, hospice and home health care. For people who paid Medicare taxes (or their spouse did) while working this coverage does not cost any money. A person might also be able to buy this coverage if they are disabled and meet residency requirements. People who are receiving disability from Social Security or the Railroad Retirement Board will automatically receive information near the time they will become eligible for Medicare. Those who are not receiving retirement benefits should [...]

The Medicare “Donut Hole”

2024-03-28T21:07:13-04:00December 17th, 2012|Categories: Costs for Treatment, eNews, Medication|Tags: |

The Coverage Gap The way Medicare Part D was designed there was a planned coverage gap, which has become known as "the donut hole". This gap has caused a great deal of confusion and higher than expected out of pocket costs for medications. When do you reach the gap? The gap begins when a person reaches a predetermined amount during the year based on average retail cost of drugs. In 2011, that amount is set at $2840. Since Medicare drug plans negotiate for a lower price the average retail cost is not what you actually paid out of pocket. Every drug [...]

Medicare and the Part D Donut Hole

2024-03-28T21:07:14-04:00December 17th, 2012|Categories: Costs for Treatment, eNews, Medication|Tags: |

An ounce of prevention is worth a pound of cure? This saying, made famous by Benjamin Franklin, is as true today as it was in the 1700's. Preventative care and early treatment can impact the outcome of most diseases. Mammograms and prostate screening are effective tools against cancer Sunscreens and limiting outdoor exposure to direct sunlight are effective methods to lower the risk for skin cancers The proper use of medication can also prevent conditions from forming or stop existing conditions from worsening. A potential growing gap is forming between what the doctor orders and what the patient may or may [...]

Dual Eligibility Medicare/Medicaid

2024-03-28T21:07:15-04:00December 17th, 2012|Categories: Costs for Treatment, eNews|

Dual Eligibility refers to a person being eligible in some way for both Medicare and Medicaid. Medicare is a federal program while Medicaid is a state program that is available to those with low income and/or resources. Medicare and Medicaid Medicare covers acute care services and Medicaid covers Medicare premiums and cost sharing expenses. Medicaid may also cover expenses for long term care. There are different types of eligibility and this link goes to a report with a table that outlines the differences http://www.medpac.gov/publications%5Ccongressional_reports%5CJune04_ch3.pdf Medicare is considered the primary insurer and covers medically necessary acute care services, including physician, hospital, [...]

Medicare and ESRD

2024-03-28T21:07:18-04:00December 17th, 2012|Categories: Costs for Treatment, eNews|

Medicare helps to pay for kidney dialysis as well as kidney transplants. Eligibility A person whose kidneys no longer work can get Medicare no matter what their age as long as they meet other criteria. You have worked long enough to qualify for retirement benefits from Social Security, the Railroad Retirement Board, or as a government employee You are already receiving retirement benefits You are the spouse or child or a person who meets either of the above criteria In order to receive full benefits you must apply for both Medicare Part A and B and wait the required amount [...]

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