If you haven’t already, now is the time to begin considering which Medicare plan you want to select for 2023 coverage. Open enrollment begins on Nov. 1, 2022 and runs through Jan. 15, 2023. If you have been diagnosed with end stage renal disease (ESRD), you likely qualify for federal coverage no matter your age. See www.healthcare.gov for more information.
In 2020, ESRD patients were also granted access to Medicare Advantage plans with the passage of a new law. Two years in, there are still some questions within the kidney community about the differences between Medicare and Medicare Advantage. The main difference is that Medicare includes Part A (hospital insurance) and Part B (medical insurance). If patients need drug coverage, they are required to enroll in a Medicare Part D plan, also known as a prescription drug plan. Medicare Advantage plans (also known as Part C) bundle the plans and may include extra benefits like vision and dental care that aren’t covered under original Medicare.
If you have additional questions about Medicare Advantage, check out our past blog with plenty of information and links to critical resources you need to make your choice.
Additionally, a Medigap plan is sometimes the best option for kidney patients. Medicare Supplemental Insurance – or Medigap – are offered through private insurers, and they cover the 20% of payments that traditional Medicare doesn’t pay for. But insurance companies are not necessarily required to sell these plans to patients under 65.
Our partners at Dialysis Patient Citizens released a 50-state report card that measured residents’ access to Medigap plans. Oregon received an “A” – meaning the state requires plans be sold to any Medicare enrollee, regardless of age, and at the same rate as those plans sold to over-65 patients. Washington, however, received a “D” because the state does not guarantee access to those under 65.
Read the report card here. DPC also has released a very helpful tool, in collaboration with Consumers’ Checkbook, that provides real-time, easy to understand information that’s tailored to a dialysis patient’s location. In minutes, patients have access to information about the doctors included in their network, the medications covered in their formulary and any additional benefits that may be available.
At the Northwest Kidney Council, we believe all patients should be informed of their plan options so they can make the best decision for them and their families.