When you or a loved one are sick, your top priority should be focusing on getting and staying healthy. Yet, those who suffer from long-term diseases are often forced to worry about how they will afford their costly, life saving treatments – like dialysis. The Centers for Medicare and Medicaid Services (CMS) strive to improve their coverage to better serve those with chronic illnesses. As an example, let’s walk through the improvements CMS is making to its End Stage Renal Disease Prospective Payment System that will take affect in 2021.
End Stage Renal Disease (ESRD) is a medical condition in which a person’s kidneys stop functioning on a permanent basis leading to the need for regular dialysis treatments. In Florida alone, 40,000+ patients suffer from ESRD. Dialysis is a physically and emotionally taxing treatment, especially for those who need dialysis multiple times perweek. Unfortunately, this life-saving treatment often comes with a hefty price tag. Regulatory changes by CMS will improve ESRD benefits in 2021, allowing families to focus on keeping their loved ones healthy instead of worrying about how to afford costly treatments.
Medicare covers dialysis treatments through its ESRD Prospective Payment System (PPS). PPS provides payment for renal dialysis services provided in a ESRD facility or in a beneficiary’s home. Beginning on January 1st, 2021 CMS will will make dialysis treatments more affordable for Medicare patients.
This improvement will dramatically change Medicare Advantage Plans in Florida for 2021, eliminating an underwriting question and allowing MA plans to allow beneficiaries currently diagnosed or seeking treatment for end-stage renal disease. as mandated by the 21st Century Cures Act. These individuals are not currently eligible to enroll in MA plans. Until now, they couldn’t get dialysis treatment under Medicare Advantage unless they were diagnosed with the disease after enrollment.
Currently, more than 85 percent of Medicare beneficiaries with ESRD travel to a facility to receive their dialysis at least 3 times per week. They spend, on average, 12 hours each week attached to a dialysis machine far away from home. In a state like Florida with an ESRD patient population that is generally older, this degree of travel can be prohibitive toward receiving necessary treatments. Thankfully, the new changes will serve to broaden coverage for at-home dialysis machines. Amidst the current pandemic, Medicare coverage is creating more opportunities for at-home treatment for patients suffering from ESRD that are likely at a heightened risk for negative COVID-19 health outcomes.
Stay safe and be well.
About Dayna Schafer
Dayna is a Certified Medicare Insurance Planner® and a member of the Rise Community. Her agency is located in St. Petersburg, FL where she has helped thousands of individuals and Medicare beneficiaries understand their benefits by ‘Making it Make Sense’. Since 2002, Dayna has certified with triple the average amount of insurers in an effort to relentlessly seek out the right fit for her client’s healthcare needs.
