"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 Hrant Jamgochian, chief executive of Dialysis Patient Citizens. "People with advanced kidney disease should not have to fear the loss of charitable support that helps them afford private insurance purchased on the exchanges created by the ACA."
CMS is focusing on premium assistance received by patients who are also eligible for Medicare, which only dialysis patients are eligible for under the age of 65. "Any suggestion that patients should not receive financial assistance if they are eligible for Medicare is nothing more than a discriminatory strategy to eliminate patient choice and access to care for kidney disease patients," added Jamgochian.
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 Medicare plans:
- A Texas patient reported that his exchange plan paid for diabetic supplies not covered by Medicare.
- An Illinois patient reported that his private coverage paid for nutritional supplements prescribed by his nephrologist, but that after switching to Medicare he had to pay for the supplements on his own.
- An Idaho patient 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 Medicare, and they benefit from the ACA's cap on out-of-pocket expenses, which doesn't apply in Medicare," said Jamgochian. "In addition, we have serious concerns about the disincentive on insurers to provide the full range of preventive and treatment services to patients who they know will soon switch to Medicare. We urge CMS to preserve the right of dialysis patients to receive help paying for private insurance plans that offer them the care they need."
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