Dialysis Patient Citizens, a patient-led organization representing dialysis and pre-dialysis patients nationwide, responded to a CMS request for information about third-party payments that help make exchange plans affordable for people with end stage renal disease (ESRD). In the request, CMS strongly suggested that it may prohibit ESRD patients with exchange plans from accepting charitable assistance that helps them pay their premiums.
"The Affordable Care Act ended discrimination against people with chronic diseases in the individual insurance market, but that core protection could be voided for dialysis patients," said
CMS is focusing on premium assistance received by patients who are also eligible for
In its comment letter to CMS, Dialysis Patient Citizens cites the real-world experiences of ESRD patients to illustrate how exchange plans offer better benefits than
Texaspatient reported that his exchange plan paid for diabetic supplies not covered by Medicare.
Illinoispatient reported that his private coverage paid for nutritional supplements prescribed by his nephrologist, but that after switching to Medicarehe had to pay for the supplements on his own.
Idahopatient reported that keeping her private plan enabled her to be treated for depression by a psychologist who does not participate in Medicare.
"Dialysis patients often need care coordination services that are not covered in
If private insurers are not required to provide coverage for ESRD patients, then they will have absolutely no incentive to offer quality kidney care or to even manage a patient's transition from Chronic Kidney Disease (CKD) to ESRD. On the contrary, it will be in the insurers financial interest to restrict patient access to such essential services as a preemptive kidney transplant, surgery for a fistula to ensure safe dialysis, or even patient education to inform individuals about steps they can take to help delay or even avoid kidney failure, in order to push those costs off onto Medicare.
"Patients pay into their private health insurance coverage for years expecting to get the care they need when they need it, not to be pushed out because they are diagnosed with a health condition," added Jamgochian.
DPC's comment letter is available here for more information.
Dialysis Patient Citizens is America's largest patient-led organization representing dialysis patients, DPC's membership consists of more than 28,000 dialysis and pre-dialysis patients and their families.
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SOURCE Dialysis Patient Citizens