Medicare Seeking to Improve Accessibility for Kidney Failure Treatment

Need assistance finding a Medicare plan that can help cover kidney failure treatment? Call our licensed insurance agents today at (800) 950-0608.

Kidney Failure Treatment Can Be Incredibly Costly

Trying to cover needed medications and treatments can be next to impossible for seniors on fixed incomes. While there is assistance available that can help cover some of the cost of complex medical treatments, it isn’t always enough. This leaves seniors paying high out-of-pocket costs that they likely do not have on hand to begin with.

Over the past few years, the federal government has been working to broaden accessibility of coverage of certain services and treatments for Medicare beneficiaries. In August, President Biden signed the Inflation Reduction Act, which allows Medicare to negotiate prescription drug prices for the first time ever. Another recent CMS initiative is to improve accessibility of kidney failure treatment, including kidney dialysis, for patients with renal disease and End Stage Renal Disease (ESRD).

Kidney failure treatment is notorious for being incredibly costly. While Medicare does cover treatments and services for patients with renal disease and ESRD, that coverage has its limitations. In the near future, however, it may be easier for renal disease and ESRD patients from all backgrounds to get needed kidney failure treatment than before.

The Changes Start With Incentivizing In-Home Kidney Failure Treatment

The treatment system for patients with kidney failure is notoriously difficult to navigate. Dialysis treatment is meant to be a gateway to a more effective procedure: a kidney transplant. However, it’s been argued that dialysis clinics have largely abandoned their responsibility to help patients get on the transplant waiting list. This is a major issue, especially for patients with End Stage Renal Disease who may be waiting on a transplant to get a chance at living a better life.

Kidney dialysis can be delivered in the comfort of a patient’s home. Receiving kidney dialysis at home yields several benefits:

• In-home dialysis is more affordable.
• Patients perform just as well, if not better, with in-home dialysis as they do with treatment provided by a dialysis center.
• Many in-home dialysis patients are able to get on the transplant list quicker, and therefore receive their transplants faster.

For years, though, in-center kidney dialysis was prioritized over in-home dialysis and treatment. CMS prioritized the in-center option for two reasons:

• They were unsure of the overall results that in-home treatment could deliver.
• In-center kidney dialysis and treatment brought in more money for the system overall than in-home treatment.

This alienated many elderly dialysis patients, especially those from more diverse ethnic backgrounds, who may not have been able to cover the out-of-pocket expenses that weren’t covered by their Medicare plans. As the rate of home-based kidney dialysis improved, so did the outlook of CMS on the program. This helped get the ball rolling for fresh prioritization of in-home kidney failure treatment.

So, What’s Changed So Far?

Starting in 2021, CMS rolled out the End Stage Renal Disease Treatment Choices model (ETC). The pilot program is seen as one of the largest of its kind in the history of American healthcare. It also heralds a more aggressive initiative by CMS to improve the quality and cost of kidney dialysis for patients with renal failure and ESRD.

After seeing that in-home kidney failure treatment provides similar, if not better, results than center-based kidney dialysis, CMS began boosting payments for home kidney dialysis. This was only the first part of a two-part incentive program designed to deliver better treatment for patients with kidney disease.

For the second part of the incentive, payments will increase or decrease for providers based on the following factors:

• How the facilities perform in-home kidney dialysis.
• The number of patients who are waitlisted for kidney transplants.
• Rates for living donor kidney transplants.

In short, it’s a win-win for both kidney dialysis patients and providers. It encourages dialysis centers to communicate with transplant providers, and renal failure and ESRD patients receive better quality of care at more affordable price points.

I’m a Patient With Renal Failure or ESRD - How Do I Make Sure I Get the Treatment That I Need?

While the system isn’t perfect, it’s making a turn for the better when it comes to kidney failure patients receiving quality kidney failure treatment. No patient should feel forced to skip the life-saving treatment that they need because of cost or lack of accessibility. If you need more coverage than what is provided by Original Medicare, you have options!

There are Medicare plans available in your area that may help you cover services and treatments that Original Medicare does not. If you’d like to get started researching and comparing available options near you, feel free to enter your zip code into our free plan finder below. If you have questions about available options, give our friendly licensed agents a call at (800) 950-0608. They’re always happy to help!