How Much Does it Cost to Treat Kidney Failure + Will Your Major Medical Policy Cover it?

Cathy Jakicic
May 6th, 2020 April 21st, 2020 |
Read time: 12 minutes
doctor holding image of kidney

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It may not inspire the headlines that some other serious health issues get, but kidney disease affects about 15% of adults in the U.S. Because in the early stages most people don’t have any symptoms, approximately 90% of those with kidney disease don’t know they have it.[1]

What causes kidney disease? There could be a number of factors, but the two main causes of kidney disease and kidney failure are diabetes and high blood pressure. If fact, between 2014 and 2016, those two conditions were linked to nearly three-quarters of kidney failure cases in the U.S.[2]

What is kidney disease? Kidney disease results when your kidneys don’t filter your blood properly, which causes wastes to build up in your blood. You may not feel kidney pain but you’ll usually feel sick. Kidney disease can also lead to high blood pressure, anemia, weak bones, malnutrition and nerve damage.[3]

Some types of kidney disease can be treated. Chronic kidney disease has no cure, though steps may be able to be taken to help control symptoms and slow the progression of the disease.[4] Kidney disease can eventually lead to kidney failure, known as end-stage kidney disease (ESKD). At that point, treatment involves either dialysis or a kidney transplant.[5]

There are things you can do to try to reduce your risk of developing kidney disease — and ways to address the resulting healthcare costs of treating the disease, up to and including treatment for kidney failure.

In the remainder of this blog post, we’ll talk about:

  • Risk factors for kidney disease and how to reduce your risk
  • The potential costs related to kidney disease and ESKD
  • Insurance options if you have kidney disease or ESKD
  • Options to pay for dialysis without insurance

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Are You at Risk for Kidney Disease?

In 2016, more than 500,000 patients received dialysis to treat kidney disease and more than 200,000 were living with a kidney transplant. In fact, according to the National Kidney Foundation, 1 in 3 American adults is at risk for kidney disease.[6]

Those with diabetes and high blood pressure are not the only people who could be at a higher risk. Additional risk factors associated with kidney disease include:

  • A family history of kidney failure
  • Age 60 or older
  • Heart disease[7]
  • Damaged kidneys (from disease,[8] such as lupus or cancer, or a physical injury[9])
  • Single kidney (it has to do twice as much work)[10]
  • Recurring or untreated kidney infections[11]
  • History of severe or recurring kidney stones[12]

Whether you fall into one of the above categories or not, there may be ways for you to maintain better kidney health.

Can You Reduce Your Risk of Kidney Disease?

Early kidney disease detection is important so that you can make lifestyle changes to support kidney health.[13] A urine test can measure the amount of protein in your urine and a blood test can indicate how well your kidneys are removing waste.[14]

The National Institutes of Health suggests you work to prevent or manage health conditions that can cause or accelerate kidney disease by:[15]

  • Reducing added dietary salt and sugar
  • Eating a variety of health-promoting foods like fruits, vegetables and whole grains
  • Limiting alcohol consumption
  • Not smoking or using tobacco
  • Adding physical activity to your routine
  • Maintaining target blood sugar, blood pressure, and/or cholesterol levels especially if you’re dealing with diabetes or heart disease
  • Having regular medical check-ups and open communication with your doctor
  • Getting seven to eight hours of sleep at night
  • Engaging in stress-reducing activities, such as yoga or meditation

Prevention is usually the most cost-effective and least invasive way to stay healthy. That said, disease progression is not fully within our control.

When kidney disease has advanced far enough, the result is kidney failure, and that requires more serious interventions and treatments. We’ll look at that next.

The Potential Costs of Treating Kidney Failure

If you experience kidney failure, you will usually need a kidney transplant or ongoing dialysis treatment.[16]

A kidney transplant replaces a diseased kidney with a healthy kidney from a donor. The kidney may come from a living donor, often a family member, or from a deceased donor. Usually just one kidney is transplanted. The diseased kidney is often left in place and the transplanted kidney is positioned in the lower belly on the front of the body. While waiting for a transplant, or if a transplant isn’t possible, kidney patients typically must undergo dialysis treatments.[17]

Dialysis removes waste and extra fluid from the blood.[18] There are two types of dialysis treatment, hemodialysis and peritoneal dialysis.[19]

About 90% of patients have hemodialysis, which involves pumping blood through an external filtration system before returning it to the body. A hemodialysis patient may need three sessions per week, for 3-5 hours per session. These sessions are generally done in a medical facility.[20]

Peritoneal dialysis uses the lining of the patient’s abdomen and a cleaning solution to clean the blood. The solution absorbs waste and fluid from the blood, using the lining of the abdomen as a filter.[21] This type of dialysis requires regular treatment, but can be done at home rather than a medical facility.[22]

The cost of transplants and dialysis vary, but both can be considerable. End stage renal disease affects almost 750,000 people each year in the U.S, and while they accounted for 1% of the Medicare population in 2018, they represented 7% of the Medicare budget.[23]

Medicare spending for transplant patient care alone is $3.4 billion annually (2018). Add hemodialysis care at an average cost of $90,000 per patient and that’s an additional $28 billion each year (2018).[24]

How Much Does a Kidney Transplant Cost?

Hospitalization for kidney failure can cost anywhere from $4,525 to $14,140 or more[25] and a kidney transplant can cost anywhere from $29,986 to $93,703 or more.[26]

In fact, before a patient can be put on the list for a kidney transplant, they have to show proof that they can pay 20% of the total bill for the surgery, or according to estimates from The National Foundation for Transplants, around $82,960 of $414,800 in total costs.[27]

And necessary anti-rejection medication for a kidney transplant can cost thousands of dollars per month.[28]

In 2017, the average wait time for a kidney transplant was 679 days.[29] While waiting for an available kidney, patients are typically undergoing dialysis and dealing with the costs of that treatment.

How Much Does Dialysis Cost?

Hospitalization for renal dialysis (including either hemodialysis or peritoneal dialysis)[30] can cost from $5,454 to $17,043 or more.[31] Hospital-based dialysis may be needed in the case of an acute kidney injury or acute renal failure.[32]

According to available Medicare data from 2016, hemodialysis to manage ESKD costs around $90,971 annually, and peritoneal dialysis can cost about $76,177 annually.[33]

Of course, a patient doesn’t pay that full amount as Medicare coverage picks up the majority of the costs. Private insurers will likely pay more for these services than Medicare,[34] so if you have an individual major medical policy or an employer’s group coverage, your treatment costs will likely be more than those of someone on Medicare and as a result, you’ll likely pay a higher amount in out-of-pocket costs.

Paying for Dialysis without Insurance
There are federal programs that may be able to help if you don’t have insurance coverage to help with the costs of dialysis.

Social Security Disability Insurance (SSDI) is an insurance plan that pays a monthly amount to those who cannot work. You earn SSDI work credits when you pay Social Security taxes. You must have enough credits based on age to qualify.[35]

Supplemental Security Income (SSI). SSI is a safety net program that pays a monthly amount to disabled children and adults who are low-income and have few assets.[36]

The American Kidney Fund is a private organization that offers small grants to U.S. dialysis and transplant patients based on need. The Fund also has grants to help with health plan premiums.[37]

Medical Insurance for Kidney Disease and Kidney Failure

There are a number of insurance options to explore if you’re dealing with kidney disease or kidney failure. Typically, you’ll start with a major medical policy, but there are other types of insurance that could help with coverage.

Qualifying Major Medical Insurance

Preventive, wellness services, and chronic disease management are on the list of the essential benefits covered by the Affordable Care Act (ACA). That means that ACA-compliant major medical policies will cover treatment for chronic kidney disease, though there are still out-of-pocket costs in the form of deductible, copays, and coinsurance that the patient pays.[38]

Qualifying health plans have no annual or lifetime limits for essential health benefits[39] and include an annual out-of-pocket spending limit ($8,200 for individual and $16,400 for family policies in 2020),[40] both of which are important for helping control your costs if you’re dealing with a chronic condition.

Even if you have health insurance coverage for dialysis or a kidney transplant, you’ll want to make sure you’re obtaining healthcare services in your plan’s network to avoid having to pay more out of pocket. Learn more about major medical insurance.

End-Stage Renal Disease (ESRD) Medicare Coverage

Medicare Part A or C are forms of ACA-qualifying health coverage.[41] Typically, adults become eligible for Medicare coverage at age 65 and after earning enough credits through payroll contributions.[42]

However, Medicare coverage may be available to those under age 65 if they have a qualifying disability – and end-stage renal disease typically counts as one. If you’re under age 65 and have been diagnosed with end-stage kidney (or renal) disease by a doctor, you may be eligible for ESRD Medicare as long as you meet other eligibility requirements (i.e., your work history or that of a spouse).[43]

ESRD Medicare provides health insurance for dialysis patients if they have permanent kidney failure and need dialysis or a kidney transplant.[44] The benefits a patient is entitled to on the basis of ESRD are for all covered services, not only those related to the kidney failure condition.[45]

To learn more about Medicare coverage for end-stage renal disease, visit the CMS website.

Visit Medicare.gov to determine your eligibility.

Supplemental Critical Illness Insurance

When we discussed qualifying major medical insurance above, we referenced some costs that you are responsible for even with comprehensive health coverage, including:

Sometimes these costs can be quite high, for example, if you have a high deductible or narrow network health plan.

One option that may be able to help is critical illness insurance. These policies generally come at a relatively low premium, but cover a limited number of illnesses, such as a heart attack, stroke, cancer or kidney failure.[46]

Critical illness insurance usually pays a lump sum – typically anywhere from a few hundred dollars up to $100,000 – to help with those costs that are not covered by traditional insurance, and for non-medical costs related to the illness, like transportation or childcare. These policies pay out once or up to a specified amount, then are done, and typically do not cover pre existing conditions.[47]

Premiums typically depend on a number of factors, including the amount of the benefit, your gender, age, health and family history.[48]

Whether or not critical illness insurance is a good option for you depends on a number of factors, including whether or not you have funds to cover your major medical policy’s out of-pocket-costs, other supplemental insurance you may have access to such as through an employer and if you are able to qualify for a critical illness insurance policy.

Learn more about critical illness insurance and whether or not it’s worth it.

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Other supplemental insurance you may want to consider include gap health insurance and hospital indemnity insurance. Both plans can help cover the high costs of hospitalization by providing supplemental benefits either as a lump sum (gap) or as a fixed amount on a per event, day, week, month or visit frequency (hospital plans).

Summary + Next Steps

Kidney disease affects about 15% of adults in the U.S. You might be at a higher risk if you have diabetes, high blood pressure, or a family history of kidney disease. Managing other chronic health conditions effectively and implementing healthy lifestyle practices may help reduce your risk of developing kidney disease or slow the disease progression.

Advanced kidney disease eventually results in kidney failure, and requires treatment in the form of dialysis or a kidney transplant, both of which can be expensive. Health insurance such as an ACA-qualifying major medical health plan with lower out-of-pocket costs, an employer’s qualifying group health plan, or ESRD Medicare coverage can help manage the high costs of treating advanced kidney disease.

And additional supplemental critical illness, medical gap or hospital insurance may be able to play a role as well if you are able to qualify and don’t have access to other savings.

If you’re considering supplemental coverage, call 888-855-6837 to speak with an agent to review your options, or obtain quotes for the health plans you’re considering to compare costs and coverage.

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Originally Published On April 21st, 2020
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