National Kidney Foundation Statement on CMS Announcement to Examine Inappropriate Steering of Patients Eligible for Medicare or Medicaid into Marketplace Plans

August 18, 2016 - The National Kidney Foundation is concerned about allegations of dialysis patients potentially being steered into health insurance options that primarily benefit the provider; but may not necessarily be in the best interests of the patient.  We agree with CMS that “Enrollment decisions should be made, without influence, by the individual based on their specific circumstances, and health and financial needs.” 

While the National Kidney Foundation does not provide premium assistance to help kidney patients pay for health insurance coverage nor do we counsel patients on the type of coverage they should choose, we do provide factual information and tools to help patients learn about their options and make informed decisions that best serve their unique needs. 

Most people with end-stage renal disease (ESRD) or kidney failure are eligible for Medicare coverage, regardless of their age; however they are not required to enroll.[1] ESRD patients who have group health coverage or individual coverage at the time they develop ESRD can choose to forgo Medicare enrollment, but may pay a late penalty for enrollment.  While most ESRD patients choose to enroll in Medicare, there are some patients for whom Medicare may not meet their health and financial needs.  As a result patients should retain the option to choose private health insurance coverage. 

Over the past few years insurance companies have developed policies, including refusal to accept third-party premium assistance, to avoid having to cover dialysis patients because of the high costs associated with their care.  The Affordable Care Act was intended to protect patients with pre-existing conditions and offer them the option to maintain or enroll in private health coverage regardless of their health status.  NKF supports extending this same protection to individuals with kidney failure.

In addition, many dialysis patients rely on third-party premium assistance to help pay for their choice in insurance coverage, whether it be for private health insurance coverage or supplemental Medicare insurance known as Medigap.  This assistance is offered by some nonprofits focused on kidney disease, however not by the National Kidney Foundation. Access to this assistance is critical for many dialysis patients and should be continued.  We share CMS’s concern about the potential steering of patients by provider-affiliated organizations, but are equally concerned about health insurance companies that attempt to limit dialysis patients’ choices through discriminatory policies. 

NKF will carefully review the request for information from CMS and provide a thorough response. We appreciate CMS’s concern for patients suffering from kidney disease and their attention to ensuring that their needs are front and center.

For a copy of the CMS press release go to: https://www.cms.gov/Newsroom/Newsroom-Center.html.

For a list of patient insurance resources go to: https://www.kidney.org/atoz/content/insurance

Kidney Disease Facts

1 in 3 American adults is at risk for kidney disease.  26 million American adults have kidney disease—and most aren’t aware of it.  Risk factors for kidney disease include diabetes, high blood pressure, family history, and age 60+.  People of African American; Hispanic; Native American, Asian; or Pacific Islander descent are at increased risk for developing the disease.  African Americans are 3 ½ times more likely, and Hispanics 1 ½ times more likely, to experience kidney failure.

The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney diseaseFor more information about the NKF visit www.kidney.org.

 


[1] Sec. 226A of the Social Security Act; 42 U.S.C. 426-1; 42 C.F.R. § 406.13(c).