How much does this cost?
I have to retire early due to chronic pain, will lose my medical insurance.
How much does PD cost? (This is the PD board, so assume that’s what you’re asking?) 93% of people who get dialysis are eligible for Medicare based on having enough Social Security quarters to qualify. Medicare pays 80% of the “allowable” rate for dialysis–which leaves the other 20% plus any pills you need to take. If you have very little income/assets, you might qualify for Medicaid to pick up that part.
There’s a Life Options booklet you can download for free called “A Kidney Patient’s Guide to Working and Paying for Treatment” that spells out how the system works. It’s at: http://www.lifeoptions.org/catalog/pdfs/booklets/employment.pdf
You say you have chronic pain that is the basis for your early retirement. Have you asked your doctor whether your pain could be related to your kidney condition? PD is a work-friendly treatment. You may want to take a medical leave of absence (you may qualify for Family and Medical Leave Act) after you start dialysis for a month or two before deciding whether to retire. This should give you time to see if you have less pain and can keep working so you can keep your income and your health coverage.
Some things related to health insurance coverage in the booklet that Guest recommended include:
– Medicare
– Medigap (Medicare supplement)
– Medicaid
– Keeping your insurance under COBRA
– Medical leave under the Family and Medical Leave Act
Does anyone know the price of the dialysis at home?
If someone has Medicare and is on Method I (see the Medicare FAQs on this site), Medicare reimburses the same amount for a week of PD as for a week of in-center hemo. PD costs on average around $400-$450/week for dialysis alone. There is some geographic variation in the Medicare reimbursement and there is a slight difference in what Medicare pays to a hospital clinic vs. one that is “free-standing.” If the patient is getting drugs, those are extra. If someone has commercial insurance, clinics usually charge more than this. Medicare requires that clinics discount their commercial payer charge.
Hi y’all,
Beth wrote:
PD costs on average around $400-$450/week for dialysis alone.
On average, Medicare pays 80% of the “allowable costs” of dialysis. So, this would be about $320-$360/week, leaving a balance of about $80-90/week or about $320-360/month that your health plan, Medicaid, or you would have to pay out-of-pocket. (This is one reason why it’s a great idea to keep a job with a health plan if you have one!)
When you first start on PD, if you have an employer group health plan (EGHP), it is primary for the first 30 months of treatment. This means it pays first and pays more. Plus, with PD (or home hemo), you qualify for Medicare as a secondary plan right away with no 3-month waiting period as you’d have for in-center hemo. So, if you have an EGHP and Medicare, you’d be likely to pay less out-of-pocket for your treatments.
After the 30 months are up (33 months for in-center hemo), Medicare becomes primary and your EGHP would be secondary.
Beth is actually better with these details than I am, so she’ll correct me if I’m wrong. 
If you have any problems that are limiting your ability to work, such as pain or phobias, you should contact a Social Security Disability lawyer now to present a good case in minimal time to the Social Security Administration.
Also you should contact your County Medicaid department and see if they are able to provide assistance. Between Social Security and Medicaid your out of pocket expenses for medical care could be very low.
If you have any assets you should contact a financial planner to minimize the impact the financial burden medical care will impose upon you and your family.
People with kidney failure who are on dialysis do not need lawyers (who charge a fee) to get Social Security Disability or SSI if they are unable to work because of their condition. Severe kidney damage and kidney failure can be debilitating enough that Social Security will grant someone SSI or SSDI as long as there is medical justification.
Those who have limited income and resources can get Medicaid without financial planners (who charge a fee). If you get SSI in most states, you’re eligible for Medicaid. States are tightening rules that prevent people from sheltering their money to get Medicaid when they don’t really need it.
If you think you may be able to work, patients have told us they were much better off financially, physically, and emotionally because they worked and had something else to focus on besides kidney disease and dialysis. A patient once said “dialyze to live; don’t live to dialyze.”
None of this is to say that if people are unable to work that they should be reluctant to sign up for disability. Nor should they be reluctant to ask for help from their doctor, nurse, dietitian, social worker, and rehabilitation professionals who can help them be sure they’re taking the medications that will make them as healthy as possible, getting enough dialysis to be at their peak health (and doing dialysis at home so they have more freedom to work), eating healthy so they feel well enough to work, learning how to cope with the stress that having a chronic illness can bring, and helping them examine their options for getting education or training and finding a job that fits with their treatment demands and physical abilities.
Finally, if you’re receiving SSDI or SSI and think that you will lose Medicare or Medicaid if you work, if you’re on dialysis, you cannot lose your Medicare as long as you pay premiums. Medicare is not based on your income or ability to work if you have kidney failure. And in some cases, if your income is low, your state can pay the Medicare premium for you.
If you have Medicaid, there are work incentive programs that allow you to keep Medicaid. If your Medicaid caseworker tells you that you can’t work, don’t believe it. Talk with Social Security. That’s the agency that can certify you for work incentive program called Section 1619 that will let you keep Medicaid. Also, some states have a program called Medicaid buy-in that lets you have Medicaid free or for a low premium.
Working is possible with kidney failure, especially with a work friendly treatment like PD.