Medicaid buy-in. In recent years, Congress has created an option for a Medicaid buy-in for disabled children and for working adults with disabilities who would not qualify for Medicaid on the basis of income. States should be encouraged to offer a Medicaid buy-in. Only approximately one-fourth of working-age End Stage Renal Disease (ESRD) patients are employed, but many of those who are not able to work do not qualify for Medicaid on the basis of previous earnings and savings. Consideration should be given to expanding the Medicaid buy-in option for the working-disabled to other adults who do not currently qualify.
Medigap. Under federal law, Medicare supplemental insurance policies are available to all Medicare beneficiaries aged 65 and older to help fill the “gaps” that exist in the traditional Medicare coverage, including deductibles, co-payments and coinsurance. Federal law does not require insurers to offer Medigap policies to beneficiaries under age 65. Fewer than half the states require even limited Medigap access for the under-65 population. By permitting the ESRD population to manage their out-of-pocket costs through the purchase of private sector coverage, states would limit their own longer term costs by minimizing the likelihood that individuals with ESRD will ultimately become eligible for Medicaid.
Out of network services. Managed care plans should pay fair rates for out-of-network dialysis services, and out-of-network policies should be clearly articulated to patients when they begin their dialysis treatment so no confusion arises after the fact. By reducing payments to providers who are not in their contracting networks, insurers restrict patient access and decrease the affordability of dialysis. For too many patients, seeing their provider of choice is no longer an option and some patients are additionally burdened by added travel time to in-network centers.
