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How the Affordable Care Act Affects Dialysis Patients

By Susan Eymann, MS29 Aug 2016

affordable-care-act-affects-dialysis-patients.jpgThe Patient Protection and Affordable Care Act (ACA or “Obamacare”), signed into law March 23, 2010, requires everyone—including children—to have health insurance or pay a penalty. The law aims to have health insurance cover the services people need so that they won’t suffer financial ruin if an unexpected medical event occurs.

Such health insurance coverage is especially important to people with kidney failure. In this sense the ACA is similar to the Medicare end-stage renal disease (ESRD) benefit that was enacted in 1972. That law allowed more people with kidney failure to receive dialysis treatments and kidney transplants. Prior to enactment of the Medicare ESRD benefit, most people with kidney failure died because there was limited access to dialysis and transplantation.

The ACA bars health plans from denying coverage because of pre-existing conditions, and prohibits insurers from dropping people from plans when they become ill. Most Americans with kidney failure are enrolled in Medicare, which means that there is no need for them to purchase additional health insurance through the marketplace. In fact, it is illegal for an insurer to try and sell a health insurance plan through the marketplace to someone who already has Medicare.

However, Medicare coverage does not begin until three months after a kidney failure diagnosis. Also, for individuals with ESRD who are not eligible for Medicare due to insufficient work credits, the health insurance marketplace may provide coverage they could not otherwise obtain.

Visit www.healthcare.gov to compare coverage options or learn more about Medicaid expansion, pre-existing conditions, dependent coverage, lifetime and annual limits, Medicare Part D rebates, and other topics that affect health care.

Download the Hemodialysis Handbook