While Medicare covers most medical costs, those without a supplementary policy must pay co-insurance, co-pays and deductibles out-of-pocket. Having to pay deductibles and co-pays not covered by Medicare can cause serious financial strain. Because of this lack of access to supplemental plans, some people with ESRD under 65 are forced to spend down their assets to become eligible for Medicaid coverage. This is financially devastating for these individuals and, in the end, will cost the State – and its taxpayers – more money.
When Medigap plans were first introduced, Congress only guaranteed issue of these plans to traditional Medicare beneficiaries and therefore did not extend this protection to those who gain Medicare coverage prior to age 65, including people with ESRD. Currently, only 28 states offer Medigap plans to people on dialysis. People on dialysis face serious financial struggles in areas where Medigap coverage is not available for people on dialysis under the age of 65. DPC continues to advocate for every person on dialysis to be able to purchase coverage through Medigap programs regardless of age.