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Medicare Coverage and End Stage Renal Disease

Gregory Gurbikian

President/CEO at Healthcare Solutions Direct, LLC, a nationwide insurance agency focused primarily on the retiree health market.

As with any Open Enrollment period for Medicare coverage, the 2020 timeframe (October 15 – December 7) means new coverage options in 2021. Understanding how changes can impact your ability to get Medicare for preexisting conditions is essential to accessing the most benefits possible from your coverage.

At Healthcare Solutions Direct, our team stays on top of these developments, making it easier for us to ensure your plan is the most comprehensive for your specific health needs. One of the most substantial changes for 2021 is the inclusion of a coverage option for those with End-Stage Renal Disease (ESRD).

Medicare beneficiaries with ESRD

ESRD occurs when an individual’s kidneys permanently stop functioning. It is also known as the advanced stage of chronic kidney disease. When kidneys stop working, dangerous levels of fluid, electrolytes and waste can build up in the body. It is an issue that cannot be ignored. Resulting treatment can range from a kidney transplant to regular dialysis sessions. Regardless, once diagnosed, ESRD becomes a chronic issue so medical costs can last a lifetime.

Nearly 750,000 patients per year in the U.S. are affected by kidney failure, and those living with kidney failure total about one percent of the U.S. Medicare population. Currently, those over 65, who develop ESRD can only get coverage through Medicare Advantage plans if they were already enrolled before they received the diagnosis. The only other way to access this type of plan, is to get grandfathered in through employer-sponsored coverage. These limitations enable only about one quarter of those on Medicare with ESRD to have options when it comes to coverage. For those without Medicare Advantage, the only option if you have ESRD is Original Medicare. This comes with multiple caveats and a lot of confusion as to what is covered and for how long.

Medicare Advantage Plans

Unlike Original Medicare, where you may have to purchase supplemental coverage to manage all your health conditions, Medicare Advantage Plans are an all-in-one alternative. These plans are more like health insurance bundles, often including Part A, Part B and Part D. There can even be extra benefits rolled into the plan such as vision, hearing or dental. Because these plans have so many components, they also have services to help coordinate care. This can really make a difference for a person juggling a chronic condition with their overall health and well-being.

ESRD coverage in 2021

The big shift in 2021 for Medicare beneficiaries is that anyone with ESRD will now have options to enroll in Medicare Advantage. This remains true even if you have already received a diagnosis. The change is a result of a provision within the 21st Century Cures Act that lifts the current restrictions ESRD beneficiaries face. This update could lead to more than 50 percent of those with ESRD gaining access to Medicare Advantage Plans over the next few years.

Benefits for ESRD beneficiaries

This improved coverage is significant when it comes to the cost of care. ESRD patients have ongoing costs associated with this condition no matter which treatment option they select. Those who undergo a transplant experience costs related to waiting for a donor match, having the surgery itself and then taking immunosuppressant drugs for the rest of their lives. Without the medication, the body may reject the transplanted organ leading to even more issues. The drugs themselves can also affect your immune system. This means more medical attention is possible as it is easier to get sick. Dialysis requires multiple treatments per week. Whether they are done at a medical facility or in the home, it is a costly and involved process as well.

Medicare Advantage Plans offer an annual out-of-pocket limit that can help ESRD patients save. The supplemental benefits and the ability to coordinate care that come with these plans can also offer significant benefits to those juggling treatment and medication costs with other medical needs. Coverage is also extensive enough to help manage any complications related to ESRD that could emerge in the future. These can include:

· Cardiovascular disease

· Anemia

· Seizures

· Infections

· Pericarditis

Having the right Medicare coverage can also mean worrying less about the cost of the care you need to continue living. Without this worry, you can turn your attention to working on your health on your own. Those with ESRD may be able to slow the progress of the disease by focusing on living an active lifestyle and eating a balanced diet. You will also need to see your physician regularly to get your blood pressure, cholesterol levels and blood sugar checked. With Medicare, it is easy to get the proper doctor appointments and lab tests to ensure your general health works for you to keep ESRD in check as much as possible.

Find the best Medicare plan for ESRD

Whether your Medicare is currently covering ESRD or not, it is important to understand how this new information could improve your coverage. At Healthcare Solutions Direct, our transparent approach to medical insurance means we are really working for you. We make sure you have the proper coverage for your own health issues, and then ensure you understand what your coverage entails. Let us help you find the right Medicare Advantage Plan, or other coverage option no matter your chronic condition. Contact us today to prepare for 2021

Contact Healthcare Solutions Direct to understand your options

Finding the right Medicare plan for your personal needs is essential to maintaining both physical and mental health in an affordable way. While getting the right coverage is important, finding the balance between care and cost is too. Let the insurance experts at Healthcare Solutions Direct help you navigate your Medicare plan options. We represent the major Medicare carriers in the US, allowing us to pinpoint the best choice for you. After pairing you with the right plan, we walk you through the entire process, supporting you the entire way. To learn more, contact us today.

The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation.

Gregory Gurbikian

President/CEO of Healthcare Solutions Direct, a nationwide insurance agency focused primarily on the retiree health market. Read Gregory Gurbikian’s full executive profile here.

About Greg Gurbikian

Gregory Gurbikian is the co-founder and President/CEO of Healthcare Solutions Direct, LLC . With over 12 years of experience in the industry, Greg is dedicated to simplifying the process for both its customers and employees.

Under his leadership and vision, Healthcare Solutions Direct, LLC has become one of the nations top agencies servicing the more than 44 million beneficiaries on Medicare. With close to 11,000 people a day turning 65, those on Medicare are projected to rise to over 79 million by 2030. Healthcare Solutions Direct, LLC is poised with cutting edge technology and training to help service the transition of those going onto Medicare from start to finish. .

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