Protecting Kidney Patients from Insurance Discrimination

New health insurance options and protections for people with pre-existing health conditions included in the Affordable Care Act (ACA) are now fully in place.  However, there were still many unanswered questions and uncertainties about specific regulations and requirements for insurance companies who decide to offer health plans in the new Health Insurance Marketplaces.  Since the passage of the ACA in 2010 the National Kidney Foundation has been advocating for answers to these questions.  Thankfully, on May 16, 2014, the Centers for Medicare & Medicaid Services (CMS) publicly released a final rule and a frequently asked questions (FAQ) document that provided some clarity for people with kidney disease. 

  1. Plans may not terminate coverage based on someone’s Medicare eligibility.  This means if you are enrolled in an individual qualified health plan (QHP) and later require dialysis or a kidney transplant, your insurance company may not end your coverage without your consent. The company must renew your coverage if you want to say enrolled, even if you also decide to enroll in Medicare.  However, the law does not require your health plan to pay the Medicare coinsurance, which is typically 20% for dialysis and other outpatient doctor’s visits.  Also, if you choose to enroll in Medicare, the amount you pay for your QHP premiums may go up because you will no longer qualify for tax credits or subsidies.  While existing law already stated that insurers could not terminate coverage based on Medicare eligibility, some insurers were unaware or interpreted the law differently. This clarification from CMS is expected to end this practice by all insurers.
  2. The FAQ document specifically states that health plans may not impose waiting periods on benefits like coverage for transplantation.  Last year, Oregon had a proposal to permit insurers to institute waiting periods, and fortunately the state decided not to move forward with that proposal.  However, Washington State did permit a 90 day waiting period and some insurers adopted it, but now the Federal government clarified that no waiting period is allowed. We therefore expect the state of Washington to overturn their policy and that no other states will allow it in the future.
  3. QHPs must make decisions within 24 hours on appeals for covering drugs for any person suffering from a health condition that may seriously jeopardize their life, health, or ability to regain maximum function. This also applies when a patient is undergoing a current course of treatment using a medication that is not on the plan’s drug formulary (e.g., a drug that is not routinely covered by the plan).  This requirement applies to combinations of medications like immunosuppressives.

If you have a QHP and have questions about your coverage, you should speak to your social worker or contact NKF CARES at 1.855.NKF.CARES (1.855.653.2273) or email nkfcares@kidney.org.

Here are links to both policy documents in case you need them as resources or simply enjoy reading complex Medicare regulations!

FAQ:  http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Final-Master-FAQs-5-16-14.pdf.

Final regulation:  http://ofr.gov/OFRUpload/OFRData/2014-11657_PI.pdf

About nkf _advocacy

The National Kidney Foundation's advocacy movement is for all people affected by CKD, transplant candidates and recipients, living and potential donors, donor families and caregivers. We empower, educate and encourage you to get involved on issues relating to CKD, donation and transplantation.
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4 Responses to Protecting Kidney Patients from Insurance Discrimination

  1. Danielle says:

    This is great news but what about the ones who only have Medicare insurance and do not qualify for Medicaid or any other Insurance due to Age and Renal Failure but NEED a secondary insurance for the 20% that Medicare does not pay for. Our Government is not helping these people in need.

    • Hi Danielle,
      We agree, and NKF has this issue as one of their public policy priorities. We plan to work to develop potential options Congress and states can use to address this. One issue we have advocated for in the past is to extend access to Medigap coverage to ESRD patients across all states, but there has been concerns that the premiums may be too high for this to make a meaningful difference for patients. We’ll keep you posted on our progress in the future.
      Thanks,
      Tonya

  2. Charles Konen Sr. says:

    March 13, 2014, The Center for Public Integrity released a report titled, “Sri Lanka bans Monsanto herbicide citing potential link to deadly kidney disease,” citing Sri Lankan President Mahinda Rajapaksa’s March 13th decision to impose an outright ban on Glyphosate. This decision follows a decision by the legislature in El Salvador last September to approve a ban on Glyphosate, but the proposal has not yet been signed into law.

    Glyphosate may be behind similar epidemics of chronic kidney disease of unknown cause in El Salvador, Nicaragua, Costa Rica, Brazil, France, and India. I believe maybe here in the USA?

    GM crops has been genetically altered to be tolerant to otherwise lethal doses of Roundup made by Monsanto. What this means is that the all GMO plants absorb the herbicide RoundUp and survive, which makes them vessels of potentially high levels of Glyphosate and when the RoundUp does not work Dioxin (Agent Orange) is used. Why else would the EPA raise the Allowable limits last year retroactive to 1 May 2013 showing up in our food and drinks about now. Naturally, when you eat this crop, you also ingest Glyphosate and or Dioxin, which makes this extremely disturbing…

    More than 50,000 people in USA die every year from Chronic Kidney Disease! One needs to ask is our GMO enhance Glyphosate rich High Fructose Corn Syrup put in our soft drinks, Fruit Juices, and baby formulas causing this? Has failed Kidneys that are removed been tested for high levels of Glyphosate combining with hard water as in Sri Lanka.

  3. Pingback: Breaking News: Conflicting Court Rulings Create Confusion Around ACA Premium Subsidies | Advocacy in Action

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