American Kidney Fund Commends Kentucky for Expanding Medigap Access to People Under 65

ROCKVILLE, Md. (April 12, 2023) — The American Kidney Fund (AKF) commends the state of Kentucky for enacting HB 345. This new law requires that Medicare supplemental policies – otherwise known as Medigap – be made available to people under 65 with disabilities who qualify for Medicare, including people under 65 with end-stage renal disease (ESRD).

Medigap is private insurance available to Medicare beneficiaries to cover the 20% in out-of-pocket costs that Medicare does not cover. Federal law stipulates that Medigap insurers must offer plans to all beneficiaries age 65 and over, but state law dictates Medigap policy for Medicare beneficiaries under 65. By passing HB 345, Kentucky has become the 33rd state to require Medigap insurers to offer plans to under-65 people with ESRD who have Medicare as their health insurance. The bill also includes critical premium protection, preventing ESRD patients under 65 from having to pay a higher premium than plan subscribers over 65.

"Battling kidney failure is challenging enough without throwing concerns over how to pay for treatment into the mix," said LaVarne A. Burton, AKF President and CEO. "AKF is indebted to Representative Kimberly Poore Moser for introducing this legislation in Kentucky, as it will give people in the state with kidney disease one less thing to worry about as they look after their health. We also extend our deepest thanks to Dialysis Patient Citizens and the ALS Association – our coalition partners – for their work in support of this legislation."

"I am thrilled to have been instrumental in passing HB 345, after much work with AKF and health plans across Kentucky," said Rep. Moser.  "This will allow those living with ESRD affordable supplemental coverage and treatment, which will improve their quality of life in so many ways. This supports Kentucky families as well, to ensure financial well-being as their loved ones get the care that they need."

Medicare covers dialysis treatments as an outpatient procedure, meaning that it covers only 80 percent of the cost of treatment. The patient must pay the other 20 percent with no annual out-of-pocket limit. Dialysis typically occurs three times a week and can cost approximately $10,000 per year or more for a patient without secondary insurance. Access to Medigap coverage can alleviate the burden of these costs, bringing some relief to patients as they cope with the tremendous financial challenges that frequently accompany a kidney disease diagnosis.

Medigap coverage also allows patients with ESRD to get on the transplant waiting list. A kidney transplant is the best treatment for those with ESRD. There are nearly 104,000 Americans on the organ transplant waiting list and more than 90,000 of them, or 87%, are waiting for a kidney. In Kentucky, of the 999 people currently on the transplant waiting list, 827 are waiting for a kidney.

AKF provides long-term financial assistance that makes transplants and post-transplant care possible for low-income dialysis patients. In 2022, AKF grants helped 1,767 people nationwide receive kidney transplants — roughly 7% of all kidney transplants performed in the United States last year. AKF's program helps post-transplant patients for their full insurance plan year, ensuring continuity of care.