Starting in 2021, folks with End-Stage Renal Disease (ESRD) can enroll in Medicare Advantage plans. Historically, if you have ESRD you have been unable to enroll in Advantage plans unless you had a plan before you were diagnosed. Let’s talk about ESRD, Medicare Advantage, and SNPs.
ESRD and Medicare Advantage
ESRD is a serious illness that requires either a kidney transplant or frequent dialysis treatments. While only a small population of Medicare enrollees has the disease (around 1%), they are responsible for over 7% of all Medicare-related costs. Sadly, this has meant that most companies offering Medicare Advantage plans are unable to do so at a profit. This has resulted in a complete block of new enrollees with ESRD. Fortunately in 2021, this has been lifted and all people suffering with renal failure can enroll in Medicare Advantage.
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Reasons to get a Medicare Advantage plan if you have ESRD
- Medicare Advantage plans often come at $0 extra cost to your Part B premium ($148.50 in 2021)
- Many plans offer basic dental and vision insurance
- Plans can also offer great benefits like transportation, gym memberships, and more
- Medicare Advantage plans have an out-of-pocket maximum, unlike traditional Medicare
If you’re interested in learning more about Medicare Advantage, check out my book on Amazon!
How to get Medicare Advantage with ESRD
If you have ESRD, it’s important to know key terms that set it apart from traditional Medicare. The two most important will be the deductible that you pay, which is the amount of money paid out of pocket until your Medicare Advantage plan kicks in. Have money set aside for this expense as it is a predetermined amount that will come right out of your pocket.
The next term to know is out-of-pocket maximum. Traditional Medicare does not have an out-of-pocket maximum, meaning that you can spend unlimited money on healthcare in a given year. A huge benefit to Medicare Advantage plans is the cap they place on out-of-pocket expenses. Once you’ve hit this amount, you will no longer be responsible for any Medicare-approved healthcare costs in a given plan year.
As a new enrollee in Medicare Advantage, you should take note of the amazing benefits that come with your plan. These can include vision and dental benefits, transportation, telehealth, and even fitness classes. Make sure to review these extras as you explore plans – they don’t often come at an extra cost!
What is a SNP plan?
Special Needs Plans, or SNP plans, are a special type of Medicare Advantage product specifically for those with chronic illnesses. ESRD falls into the chronic illness category, thus is eligible for a SNP plan.
These plans can be tailored to the needs of ESRD patients, meaning certain services, drugs, and products are included at a better price. I highly recommend looking for an ESRD-focused SNP Medicare Advantage plan. This will allow you to receive personalized coverage including coverage for things that you know you will use.
Cost of Medicare Advantage if you have ESRD
ESRD Medicare Advantage plans have a monthly premium, or amount paid each month to be a “subscriber” of a plan. These costs are in ADDITION TO your Medicare Part B monthly premium. While many plans have $0 premiums, others will add a cost each month to the amount you already owe Medicare.
Make sure to review your premium, deductible, coinsurance, and out-of-pocket maximum before you finalize your plan selection. Understanding your coverage will help you make the best financial decision. As mentioned before, I always recommend setting aside enough money to cover your deductible, and if possible, your out-of-pocket maximum. This practice helps ensure that you are able to afford your health expenses even if they far exceed what you expected.
What about drugs?
While traditional Medicare forces you to purchase a Part D prescription drug plan separately, most Medicare Advantage plans cover prescription drugs. As an added benefit, SNP plans are required to cover prescription drugs.
If you need help sorting through this or curious if you are eligible, contact me for help.