Most ESRD patients become eligible for Medicare three months after diagnosis, and most patients with ESRD are enrolled in Medicare as their primary health insurance coverage. For many of these patients, private supplemental Medigap insurance is needed to afford their cost-sharing, as Medicare Part B covers only 80 percent of medical care with no cap on out-of-pocket (OOP) expenses. ESRD patients have complex health care needs and face high out-of-pocket costs—the average OOP costs for ESRD patients on Medicare are $7,000 and the average annual income of HIPP grant recipients is just under $25,000. However, in 20 states Medigap is not required to be made available to ESRD patients under the age of 65, and these patients represent a sizable portion of dialysis patients in those states—about 92,000.
On the federal level, we support legislation that would ensure guaranteed availability of Medigap supplemental insurance to all Medicare ESRD beneficiaries, regardless of age. Most recently, this provision was included in the Chronic Kidney Disease Improvement in Research and Treatment Act, which was introduced in the previous congress and expected to be reintroduced in this congress. We also support the passage of state legislation that would require insurance companies that offer Medigap coverage to offer it to ESRD patients under 65 and that would place limits on the premiums charged to ESRD patients so that Medigap is affordable.