The Financial Cost For Kidney Patients
The United States Renal Data System’s 2010 Annual Data Report and 2011 Annual Data Report state that 1 in 10 adults have a form of kidney disease. This amounts to more than 20 million Americans in the United States.
A large majority of individuals with kidney disease will have to undergo a kidney transplant. As a result, the financial burden for kidney patients can be extremely costly.
According to a report in 2013 entitled ‘Atlas of Chronic Kidney Disease and End-stage Renal Disease in the United States’, the average cost to Medicare per person in 2011 for a kidney transplant was approximately $88,000 for hemodialysis, over $71,000 for peritoneal dialysis and $33,000 for the actual transplant.
Although the cost to Medicare is high, the out of pocket costs that kidney patients must pay are even higher.
This is because there are many steps and processes that need to be completed in order to have a successful kidney transplant. Kidney patients will undergo several steps before a transplant, during the transplant and after the transplant. All these steps will require a number of costs and medical expenses including:
– Cost for your in-hospital stay during recovery
– Extensive lab tests before transplant takes place
– Anesthesia during the procedure
– Donor’s costs (transportation, accommodation, medical tests and medication)
– Fees for transplant surgeons and operating room personnel
– Organ recovery from donor
– Accommodation and other basic living expenses during the time of hospitalization. This is particularly for children, family members and loved one who are supporting the patient.
– Physical therapy and rehabilitation after transplant is complete
– Anti-rejection drugs and other medications
The United Network for Organ Sharing (UNOS) estimates that a kidney patient can be charged more than $262,000 of medical expenses in the first year alone. This does not account for any further medical expenses in later years including rehabilitation and therapy services.
Drugs and medication are also another big expense that patients will need to cover. Here are some average costs for a few drugs that are typically required for kidney patients:
– Cellcept: $1064 monthly
– Prograf: $1,340 monthly
– Prednisone: $12 monthly
– Myfortic: $806 monthly
Costs can also vary between patients depending on the length of time a kidney transplant patient is required to stay at the intensive care unit (ICU).
Where To Find Financial Help For Kidney Patients
There are a number of useful resources and financial assistance options for kidney patients who are in need of financial aid. Here are 14 options for financial help for kidney patients available in the United States.
Medicare is a federal government run program that is open to kidney patients to seek financial assistance for the purpose of kidney transplants, medication, and other related medical expenses associated with their treatment.
Medicare can be understood as a form of health insurance that is broke down into two parts. The first is Part A. This is your hospital insurance. The second is Part B, which is your medical insurance.
Kidney patients will require to cover the cost amounting approximately to $1,156 for hospitalizations. This is the out of pocket costs under your hospital insurance policy. Every time you are hospitalized, you may be required to pay this cost.
Kidney patients will also receive coverage in Part B for physician services, where a patient must pay $140 per year in order for Medicare to cover 80 percent of your total physician costs. Note that patients will still require to pay 20 percent of the costs that are not covered by Medicare.
An estimate of costs is approximately $4,000 for hospitalization fees when undergoing a kidney transplant. Some items may not be covered and it is important to review what is covered beforehand. For example, Medicare will cover fees associated with erythropoietin, which is a drug to treat anemia in kidney failure as well as immunosuppressants, which helps prevent rejection of a transplanted kidney. However, patients will still also cover a larger percent of the anesthesiologist’s bill, amounting to about $400-$500.
In addition to Part A and B, patients will also be able to access Part D of the Medicare insurance policy. Kidney patients can receive coverage for prescription medications.
2. Social Security Disability Insurance (SSDI)
Social Security Disability Insurance otherwise known as SSDI is also another insurance plan run by the federal government. This insurance plan gives a monthly financial assistance amount to individuals who have kidney disease and are unable to work during the time of treatment.
3. Supplemental Security Income (SSI)
SSI or Supplemental Security Income is a safety net program created by the federal government that assists individuals with a disability with financial assistance monthly. If you are approved on this program, you may also be eligible for other benefits including food stamps that can assist with household costs and food expenses.
Medicaid, not to be confused with Medicare, is a federal government program that runs nationally in the United States. The purpose of this program is to assist individuals who have low incomes, few assets and no health insurance to be able to receive proper medical care and treatment.
Kidney patients who meet these requirements can receive financial assistance through this program. Each state runs their own version of Medicaid, where there are a range of benefits that patients can access. Speaking to your social worker at the Social Services office can help give more clarification on what is available to you for your unique circumstances.
5. Kidney-specific state assistance programs
There may also be assistance programs in your state that provide kidney-specific financial assistance. These select programs are only available at various states. Eligibility and availability of the programs are subject to the state’s regulations and requirements.
To find out what options are available to you in your state, speak with the dialysis or transplant clinic social worker in your local department office of Social Services. Alternatively, a general social worker in your hospital can help determine your best options for financial assistance.
6. American Kidney Fund
The American Kidney Fund provides grants to individuals looking for financial help for kidney patients. If you are living in the United States on dialysis as well as patients in need of a transplant. You can receive help paying health plan premiums to ensure that you receive the proper medication, treatment and care you require.
It is mandatory that patients speak with the on-call social worker to start the process of applying for such funding. Funding is limited to patients who show a true need of financial assistance.
7. National Kidney Foundation
The National Kidney Foundation provides assistance in many ways for kidney patients. They offer national services and programs to help kidney patients with nutrition, transportation, medications, as well as scholarships.
In order to receive financial assistance from the organization, you must get in contact with your local office and setup a time to speak with the social worker. The social worker will check your eligibility and assist you to apply for grants and funding.
8. State Pharmaceutical Assistance Programs
State Pharmaceutical Assistance Programs is available in 22 states across the United States. Kidney patients can receive free medication as part of the partnerships with select pharmaceutical companies and the state government.
9. The Partnership for Prescription Assistance
The Partnership for Prescription Assistance programs are offered nation wide in the United States for kidney patients. There are over 475 programs listed on the official website, which outlines what benefits patients can receive, the out of pocket costs involved and the eligible requirements.
Each program is run by a pharmaceutical company where select drugs and medications are offered either completely for free or at discounted prices through a reimbursement structure or a co-payment plan.
Patients can find these programs useful to cover other costs that may not be approved or covered on Medicare. This includes any self-administered drugs and other medications that your doctor prescribes to you as part of your treatment plan.
10. Donated Medication Program
The Kidney and Urology Foundation of America offers a program called Donated Medication Program, where partnerships with large pharmaceutical companies offer kidney patients free medication for a period of time. One example of this is Genzyme’s Renal Patient Assistance Programs, which patients are offered two drugs that are most commonly used for dialysis.
This is a short-term option where patients can receive up to 4 months of medication for free. If you require further help after 4 months, the program offers the grant certain times of the year, where individuals can reapply for an extension of their medication allowance.
11. Pediatric Summer Enrichment
The Kidney and Urology Foundation of America offers a range of programs to help kidney patients young and old. One of these programs called the Pediatric Summer Enrichment program offers assistance specifically to children who are on dialysis and children who have completed a kidney transplant. This program offers small grants of $200 for families as well as activities for children such as camps and retreats.
12. Private Insurance
Private insurance and full coverage health insurance can be great options for kidney patients who require help financially. Majority of private insurance policies will cover the entire cost of treatment, or a high percentage of the overall cost.
Patients should research a range of policies available, weigh up costs and review each with your medical provider for the best fit. Ensure that the types of expenses that may be billed by your hospital and doctor are covered completely by the insurance policy. If they are not covered by the insurance completely, make sure you are aware of the out of pocket costs that you will incur.
Before making any decisions, ask as many questions as you require to make the right decision.
13. California Pacific Medical Center
The California Pacific Medical Center offers financial assistance to patients who are looking for kidney, pancreas, liver and heart transplantation.
14. PeoplePledge Fundraising Campaigns
PeoplePledge is an online website that offers kidney patients the opportunity to create and run a free online fundraiser. Patients can reach out to family, friends and extended networks to raise funds needed for a kidney transplant. This is particularly useful for patients who are unable to afford their medical expenses or who do not have full health insurance coverage.
Patients can raise funds to cover the bulk of expenses including food, lodging, donor fees, hospital fees and the transplant surgery.
1) Financial Help for Treatment of Kidney Failure: http://kidney.niddk.nih.gov/Kudiseases/pubs/financialhelp/
2) costs of chronic kidney disease: http://www.usrds.org/2012/pdf/v1_ch7_12.pdf
3) Tackling the Financial Challenges of Kidney Disease: https://www.aakp.org/education/resourcelibrary/dialysis-resources/item/tackling-the-financial-challenges-of-kidney-disease.html
4) Financial Help for Treatment of Kidney Failure: http://www.kidneyurology.org/Library/Kidney_Health/Financial_Help_for_Treatment_of_Kidney_Failure.php
5) Costs and Financing of Kidney Transplant: http://www.cpmc.org/advanced/kidney/patients/topics/financing_kidney_transplant.html
More Kidney Patient Financial Help Resources
- Kidney failure treatment payment plan Kidney failure is a chronic condition that demands immediate medical attention. If the kidneys of an individual fail then an urgent treatment is required to make them function normally again. Such a medical emergency means that some extremely important decisions that would be needed for the treatment. This may include what type of treatment one ... Read more