End Stage Renal Disease, otherwise known as kidney failure, is a grueling condition for which there is no cure. ESRD patients must undergo thrice-weekly dialysis treatments or a kidney transplant to stay alive. Since receiving a transplant requires years of waiting, dialysis is the lifeline for ESRD patients, the difference between life and death. When ESRD patients receive dialysis, they can live normal, productive lives.
Dr. Roxana Chicas
Unfortunately, many in the state of Georgia still struggle to afford dialysis care. Dialysis is extremely expensive, costing an average of $90,000 a year, according to the US Renal Data System. Hence, most dialysis patients rely on Medicare to pay for dialysis; however, Medicare only covers 80% of treatment costs. To pay for the remaining 20%, dialysis patients in Georgia must either rely on employer-sponsored plans, Medicaid, or pay for a Medicare supplemental insurance plan, which are called “Medigap” plans.
While federal law requires states to provide affordable Medigap coverage for dialysis patients over 65, it does not require the same for those under 65. States can choose to offer affordable Medigap coverage to younger patients, but unfortunately, Georgia has so far chosen not to do so. For ESRD patients who do not qualify for Medicaid, the difference in price between older patients and younger patients is about $1,500 per month. This affects roughly 5,400 non-dual eligible ESRD patients in Georgia, or ESRD patients under 65 on Medicare who do not qualify for Medicaid.
Charging these patients exorbitant premiums makes little sense given that ESRD is a condition that affects people of all ages. Georgia nonetheless allows private insurers to charge non-dual ESRD patients unjustifiably higher premiums for Medigap plans. Thus, this small population of Georgians potentially face extreme financial insecurity and medical debt. The monthly costs of covering necessary, life-saving treatment is simply too high.
Who has an extra $1,500 available every month? These 5,400 Georgians certainly do not! Georgia’s lack of affordable Medigap access forces many patients to spend down their assets just to qualify for Medicaid, as the state then covers the 20% out of pocket costs. Dialysis patients must make themselves poorer and join the state’s public assistance system just to survive, costing the state of Georgia millions.
This faulty approach to Medigap coverage also impacts patient access to kidney transplants. Patients must have secondary insurance coverage to be eligible for a kidney transplant to cover any post-surgery treatments and follow-up costs to keep transplanted kidney patients as healthy as possible. A significant portion of those roughly 5,400 non-dual eligibles will be denied a kidney transplant unless they have this coverage, which many Georgians do not have because of how unaffordable Medigap plans are in our state.
Today, there are about 2,500 Georgians under age 65 on the national transplant waitlist. Georgia’s gap in the law essentially denies these Georgians the ability to be placed on the active transplant waitlist and allows ESRD patients from other states with Medigap coverage to come to Georgia for a kidney transplant. This is unacceptable, and something must be done.
The Georgia General Assembly’s new legislative session began in January. Georgia can follow the lead of 16 other states, including Kentucky and Virginia who passed laws in 2023, guaranteeing affordable Medigap coverage for ESRD patients regardless of age, ensuring those under 65 who don’t qualify for Medicaid can still access important treatments. Expanding Medigap coverage to all patients would save Georgia millions in budgetary expenditures while preventing vulnerable patients from slipping through the cracks. It’s a no-brainer.
The number of Georgia ESRD patients under 65 who lack access to Medicaid and other supplemental plans is small, but that doesn’t mean they should be discriminated against. Georgia lawmakers must do the right thing and ensure that every ESRD patient can afford the treatments they need to survive.
Roxana Chicas RN, PhD is an Assistant Professor at the School of Nursing at Emory University with a research focus on nephrology and postdoctoral training in the Renal Division of the School of Medicine at Emory University. Dr. Chicas is also a kidney donor.
