NKF Calls for Affordable Medigap Coverage for Kidney Patients Under 65

Medigap, also called Medicare Supplement Insurance, is insurance sold by private companies that helps pay a patient's share of costs under Original Medicare. Different levels of coverage are offered with various premiums. Depending on the policy, it can help cover coinsurance, copayments, and deductibles.

People with kidney failure can qualify for Medicare before age 65. However, federal law generally does not require insurance companies to sell Medigap policies to people under 65. That leaves some kidney patients without access to an important source of financial protection.

Learn more about Medigap plans.

Dialysis is a life-sustaining treatment. For someone receiving dialysis in a clinic, treatment typically happens three times each week. Under Original Medicare, patients generally owe 20% of the Medicare-approved amount for outpatient dialysis after meeting their Medicare Part B deductible. Without supplemental coverage, Original Medicare has no annual limit on these out-of-pocket costs.

In its letter, NKF explained that dialysis coinsurance alone can add up to nearly $9,000 in 2026 for a patient without supplemental coverage. Medicare premiums and other health care expenses can add to that burden. Having health insurance should help patients get the care they need without overwhelming medical bills.

Read NKF's letter.

NKF's letter highlighted that at least 15 states do not guarantee Medigap access for people under 65 with kidney failure. Some states do not require insurers to offer policies to anyone under 65, while others have protections that exclude people with ESRD.

Even where policies are available, high monthly premiums can put coverage out of reach. A right to buy insurance offers little protection if a patient cannot afford it.

People with kidney failure can choose between Original Medicare and Medicare Advantage, which provides Medicare coverage through private health plans. Medicare Advantage can be the right choice for some patients and includes an annual limit on out-of-pocket costs for covered medical services. However, plans may have limited provider networks and require approval before certain services, known as prior authorization. These rules can be especially important for people seeking a kidney transplant.

Patients should be able to weigh these options based on their doctors, treatment needs, and transplant goals. A lack of affordable Medigap coverage should not push someone toward a plan that may not meet those needs.

NKF urged Senator Wyden and the Senate Finance Committee to establish a federal right to buy Medigap coverage for people under 65 who qualify for Medicare because of ESRD, paired with protections that keep premiums affordable. Together, these changes would help close the gap between having Medicare and being able to afford care.

A kidney failure diagnosis should not leave someone facing unaffordable medical bills or limited coverage choices because of where they live. NKF will continue advocating for policies that protect access to care and give kidney patients meaningful choices. Help support this work. Become a Voices for Kidney Health advocate.