Stages of Kidney Disease

According to my nephrologist’s office assistant, my diagnosis is “CKD #4, nephrology/nephritis”.

I just got on Medicare and am considering a supplemental plan (an HMO). In the application, they ask if I have “End Stage Kidney Disease”. Do I?


You have chronic kidney disease, which means you have damaged kidneys, but they are still working. Stage 4 means that your kidney function is between 15 and 29%. You do not yet have End Stage Renal Disease. Doctors diagnose ESRD when someone’s kidneys fail and he/she needs to start dialysis or have a transplant to survive.

Are you sure the plan you’re considering is a Medicare supplement or is it a Medicare Advantage plan (Medicare HMO)? Medicare HMOs are another type of Medicare that provide health and drug coverage if you go to the HMO’s providers or get referrals to go to specialists. Some patients with ESRD have complained about their Medicare HMOs costs and limits on choice.

Be sure to ask what your out-of-pocket payments would be for doctors and outpatient treatments with the Medicare Advantage plan. If you have the option to pay a higher premium in the Medicare Advantage plan and it will cover health and drug deductibles, copays or coinsurance I’d strongly encourage you to to do that. Believe me…you’ll come out ahead. If you don’t, you could end up paying more out-of-pocket because some Medicare Advantage plans require a copay for each dialysis treatment. How much you’d pay depends on whether the Medicare Advantage plan counted PD as a monthly treatment requiring one copay or as a daily treatment requiring you to pay 30 copays.

People who have Original Medicare may sign up for a Medigap plan that pays 100% of the Medicare deductibles and coinsurance.