Article

Types of health insurance

An African American woman choosing health insurance coverage on a laptop

Health insurance helps you afford the costs of health care. When you have kidney disease, you will need to figure out how to pay for your treatments, such as doctor visits, lab tests, dialysis or a kidney transplant (surgery to give you a healthy kidney from someone else's body). Learn about the different types of health insurance and what they mean for kidney disease.

What is health insurance?

Health insurance is coverage for the costs of health care services that you need, such as doctor's visits, hospital stays, medical procedures, lab tests and more. It can protect you from the high costs of health care. Often, you pay a monthly bill (a premium) for your health insurance coverage.

What are the types of health insurance?

There are a wide variety of types of health insurance. Here are some of the most common types.

Health insurance through your job

Many people have health insurance through their–or their spouse's or parent's–employers. The employer pays for part of the health insurance plan, and the employee pays the rest of the cost as a monthly bill (premium). 

Job-based insurance plans usually cover the costs of health care services you use, such as  doctor visits, hospital stays and lab tests. Most plans share the costs of health care, which means you will have some out-of-pocket costs, including:

  • Copays: A set amount you pay each time you get a health care service.
  • Deductibles: A certain amount you must pay before insurance will pay for the cost of health services.
  • Co-insurance: A percent of the cost of health services you must pay after you meet your deductible.

Plans vary widely in the services they cover and the amounts of deductibles, copays and coinsurance. Read the Summary of Benefits and Coverage from your insurance company for details on your specific plan.   

Medicare

Medicare is a federal government health insurance plan for Americans who: 

  • Are age 65 or older
  • Are of any age and have certain disabilities
  • Are of any age and have kidney failure and need dialysis or a kidney transplant (end stage renal disease, or ESRD)

Nine out of 10 Americans with kidney failure have Medicare.

What does Medicare cover?

For people with kidney failure, Medicare covers: 

  • Dialysis treatment at a dialysis center, three times per week. This also includes help you get through your dialysis center, such as help from a social worker or dietitian.
  • Dialysis you do at home, including: 
    • The cost of equipment and supplies you need 
    • Training for you and someone who helps you with home dialysis
  • Most medicines you take as part of your dialysis treatment
  • Kidney transplants, including:
    • The cost of the hospital stay and doctor's services for surgery (including both the transplant recipient and donor)
    • Lab tests before and after surgery, such as blood or urine (pee) tests
    • Medicines you will need to take after your transplant     
    • Any costs involved in finding a kidney, such as joining a kidney registry

What will I have to pay?

To get the part of Medicare that covers dialysis, you must pay a monthly premium and reach a deductible (an amount you must pay out of pocket before insurance will pay for the cost of health services). 

For a kidney transplant, the transplant recipient must pay a deductible for the cost of surgery, and a deductible and coinsurance for the cost of any rehab care you need in a skilled nursing facility after surgery. Medicare covers the full cost for living kidney donors (a living person who donates a kidney for a transplant).

If you have questions about Medicare, or if you're eligible for Medicare because of your kidney disease and want to enroll, visit the Medicare.gov website, your local Social Security office or call Social Security at 1-800-772-1213.

Children's Health Insurance Program (CHIP)

The Children's Health Insurance Program (CHIP) offers Medicare coverage for children (an unmarried person age 21 or younger) with kidney failure. It helps cover the costs of dialysis, a kidney transplant and other treatments. 

Even if you have other health coverage for your child, enrolling them in Medicare can help make sure they are covered if your other coverage changes in the future. Call 1-800-MEDICARE (1-800-699-2273) to learn more.

Medicaid

Medicaid is a government program that provides public health coverage to low-income adults and children who qualify. Each Medicaid program is run by its own state, and whether or not you qualify depends on the rules in the state where you live. 

Many people with end-stage renal disease (ESRD) rely on Medicaid to pay for their health care, usually as a supplement to Medicare.  

Visit the Medicaid.gov website to find where to ask questions about whether you qualify, what services are covered, how to enroll and more.

Individual health coverage

Individual health coverage is health insurance that you buy and pay for yourself. You can buy individual health plans in two ways:

  • On the HealthCare.gov marketplace (the website created as part of the Affordable Care Act). There, you can shop for plans and sign up for a plan that works for you. You may qualify for plans with low premiums or deductibles, depending on your income. 
  • Directly from a health insurance company. This may be an option if:
    • Your employer does not offer health insurance, or you work part time 
    • You are self-employed
    • Plans on the HealthCare.gov marketplace are not a good match for your needs
    • You retire and are under age 65

You can contact companies that sell health insurance yourself. You may choose to work with an insurance broker (a person who helps you shop for insurance for a fee) who can help you find a plan that works for you.

TRICARE

TRICARE is the health care plan for members of the U.S. military and other uniformed services and their families. TRICARE covers: 

  • Dialysis and hemodialysis and services for people with kidney failure
  • Kidney transplant surgery for recipients and living donors, if both are covered by TRICARE. Living donors who are not covered by TRICARE may have to pay out-of-pocket costs that are not directly related to the transplant surgery.

Veterans enrolled in health care through the U.S. Department of Veterans Affairs (VA) can get health care for chronic kidney disease or kidney failure through the VHA National Kidney Program. This program covers services including dialysis and kidney transplants for eligible veterans.

COBRA

COBRA is a federal law that allows you to continue coverage in a group health plan (such as a plan through your employer) for 18 months after an employer stops paying part of your premium. This may happen if you or your spouse lose a job or get a cut in hours, or if you lose your spouse's coverage because you get divorced or your spouse dies. 

Your coverage will usually stay the same as when you or your spouse were employed. Health care for kidney disease that was covered under the group health plan will usually also be covered under COBRA. Your monthly premiums are usually much more expensive compared to what you paid as an employee. 

When you lose your employer coverage, you will get a letter with information about COBRA coverage and how to enroll.