Does Health Insurance Cover Kidney Transplants?
The majority of health insurance plans cover kidney transplants, which is good news for those facing the high costs of receiving one. Dealing with kidney failure and the process of finding a donor for a transplant can be stressful enough without worrying about how you are going to pay for everything.
The best-case scenario when it comes to getting a kidney transplant covered by insurance is to already have the insurance plan in place. If you need a transplant but do not have a current health insurance policy, your options for coverage dwindle quite a bit. Don’t panic, however, as there are other options available if insurance isn’t one of them.
What does health insurance cover in regard to kidney transplants?
If you need a kidney transplant and you have health insurance available, don’t assume that the procedure will be covered. Transplants are sometimes covered under optional coverage, which means that if you didn’t choose it when you first signed up for coverage you will not have that benefit.
Read through your policy to see if a transplant is listed as a benefit and what exactly it covers. Keep in mind that a kidney transplant is a complicated process and there are a lot of things involved with it. Your insurance coverage may include some of the medications necessary but not all of them. It may cover the surgery but not follow-up care. Don’t assume that everything you need will be paid for with insurance.
Check for things such as if your transplant center is covered under your plan or if you need to go to a different facility. Look at your deductible, your co-pays for all of the procedures, lab tests, and medications, and if you need to get pre-authorization. Because the process involved with a kidney transplant can be long and drawn out, see if there is a maximum amount that your insurance plan will cover.
If you are unfamiliar with how insurance works, have someone in the billing department at your transplant center call your insurance company and ask what is covered. Anything that your insurance plan does not pay for is your responsibility, so make sure you have all of the details so there aren’t unpleasant surprises along the way.
Is insurance difficult to get for kidney transplant patients?
If you currently do not have health insurance, finding insurance coverage to cover your transplant will be difficult. If you are looking for individual insurance you will be considered to have a pre-existing condition, which usually results in you getting denied for coverage, or at least a denial for any benefits pertaining to your kidney.
The best route to take in order for your transplant to be covered is to look for group insurance. The benefits of having group insurance are that it doesn’t consider pre-existing conditions, its deductibles are usually lower, and its coverage is usually broader than with individual insurance.
If you are working, check with your employer to see if health insurance is available. If it is not an option or you are unemployed, check to see if you can get covered under your spouse’s plan.
Another option for group insurance is to check with your state to see if there is a health insurance pool for high-risk individuals. These plans often cost more, but your kidney transplant should be covered under the plan.
What are alternative options to private health insurance for kidney transplants?
If you don’t have private health insurance that covers kidney transplants, you may feel overwhelmed with the financial burden that accompanies a transplant. Fortunately, there are other options for you to explore.
The National Kidney Foundation reports that the majority of patients who get kidney transplants are Medicare qualified. Medicare pays for 80% of the surgery costs, plus 80% of the anti-rejection medications needed. Other medication costs will be your responsibility.
Although Medicare benefits for the anti-rejection medications end after three years, if you are entitled to Medicare benefits because of disability or your age, there is a good chance your meds will continued to be covered.
Every state also has a State Health Insurance Assistance Program. These offer free assistance and counseling for those who are having difficulty paying for certain health matters. Medicaid may also be an option for low-income families.
You may want to try non-insurance routes, such as certain non-profit groups. Some organizations that may be able to help out financially include the National Transplant Assistance Fund, Association for Children’s Organ Transplant, American Kidney Fund, and National Kidney Foundation.
Most transplant centers will have staff on hand to help guide you through the process of figuring out how to pay for your kidney transplant. If you do not have health insurance to help cover your expenses, don’t give up. Research all of the options available so that you can get the best care possible.