Expanding Medigap Is Essential to Protecting Patients With Kidney Failure

John “Jack” Reynolds from Carlisle, Iowa, was only four years old when he sustained an injury resulting in lifelong kidney failure. He depended on four-hour dialysis treatments three days a week for the rest of his life, until passing away from kidney failure at age 64. Jack was fortunate to have access to secondary insurance coverage to pay for the out-of-pocket expenses of his treatment, but many in his situation, both in Iowa and across the rest of the country, are excluded from this coverage.

Patients with kidney failure, or end-stage renal disease, are not guaranteed access to vital secondary medical insurance called Medigap, often leaving them in an extremely vulnerable financial situation, and, in some cases, preventing them from being added to the transplant waiting list. Transplantation is considered the best option for patients with kidney failure.

While Congress made sure that all ESRD patients could have access to Medicare, they left it up to the states to determine whether Medigap would be available to those under 65. The decision has left a patchwork of Medigap availability nationwide. Currently, there are 20 states where Medigap insurers are not required to offer plans to Medicare beneficiaries with kidney failure who are under the age of 65 — leaving many Americans struggling to afford the treatments they need to live. Capping coverage based on age is discriminatory, especially when 53 percent of dialysis patients nationwide are under the age of 65.

Nearly 556,000 Americans across the country rely on dialysis, an exhausting and time-consuming treatment. Most dialysis patients must organize their lives around going back and forth to treatment centers, a schedule that has been further complicated by COVID-19. Kidney-failure patients are among the most vulnerable populations for severe illness from COVID-19, and they have had the highest rate of COVID-19 hospitalization among all Medicare beneficiaries. Further, patients who are immunocompromised, including transplant patients, dialysis patients and patients requiring immunosuppression for treatment of kidney disease, may not build the same level of immunity from the COVID-19 vaccine as others.

On top of the rigorous treatment schedule and the added risk of infection, kidney care is a huge financial burden, with 1 out of every 7 dialysis patients turning to the American Kidney Fund for assistance because they are unable to afford the cost of care. This is not surprising, as more than 75 percent of dialysis patients are unable to work.

Given the complexity of kidney failure, Medicare covers 80 percent of the cost of medical care for most Americans with ESRD, regardless of age. However, the other 20 percent — upwards of $10,000 per year for the average dialysis patient —must be paid by a secondary type of insurance, or out of pocket by the patient. While Medicare coverage of ESRD is a lifesaver for patients, there is no out-of-pocket cap, and patients without secondary insurance can easily spiral into bankruptcy, especially those in states that don’t offer Medigap to everyone. And Medicare coverage alone is typically not considered sufficient insurance coverage for an ESRD patient to be placed on the transplant waiting list.

When Jack Reynolds wasn’t completing his many hours of dialysis, he was traveling to Washington, D.C., and advocating for better kidney care and insurance coverage. While in Washington, Reynolds met with Rep. Cindy Axne (D-Iowa) to share his story and push for expanded Medigap coverage. His efforts paid off. In the fall of 2020, Axne—along with Rep. Jaime Herrera Beutler (R-Wash.) — introduced a bill in Jack’s honor, called the Jack Reynolds Memory Medigap Expansion Act. The legislation would require insurers to offer Medigap plans to all Medicare beneficiaries, closing coverage gaps for patients around the country who did not yet qualify for Medicare.

Jack Reynolds may not be here to benefit from the legislation that bears his name, but it could save the lives of 100,000 Americans under 65 who are on dialysis and whose states do not require insurers to offer them Medigap. It is vital that Congress take action to protect all Medicare beneficiaries across the country, regardless of age and what state they live in, by enacting this important legislation.


LaVarne Burton is the president and CEO of the American Kidney Fund.

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