Nearly 800,000 American adults live with end-stage renal disease (ESRD). A recent CDC report found that from 2000 to 2019, new ESRD cases increased by 42% and the number of people living with this stage of the disease nearly doubled. ESRD is a form of chronic kidney disease marked by a gradual loss of kidney function over a period of months to years that advances to the point the kidneys no longer function properly. As a result, dangerous levels of fluids and waste build up in the body, leaving dialysis or a kidney transplant as the only available treatments.
Dialysis usually involves connecting a patient to an artificial kidney machine to do the filtering (called hemodialysis), although another type of dialysis (peritoneal dialysis) uses the abdominal lining to filter blood internally. ESRD is unique within the American health care system, as it was the first – and for decades, the only – health condition for which Congress authorized Medicare coverage based on diagnosis. In addition to being eligible for Medicare, many individuals living with ESRD are also enrolled in employer-provided coverage.
A recent analysis from AHIP’s Center for Policy and Research found that nearly all dialysis treatments are covered as in-network procedures by group health plans. All dialysis service codes were processed as in-network 95.3% of the time, for example, according to the review of dialysis claims for calendar year 2020.
Employer-provided health plans typically include substantial coverage of dialysis services for those with ESRD. With more than 95% of dialysis treatments available in-network, employer-provided coverage ensures those with ESRD have access to the routine dialysis they need at high-quality, accountable providers and at lower out-of-pocket cost.
Earlier this year, AHIP responded to a federal Request for Information (RFI) on ESRD Facilities, in which AHIP offered real solutions for improving care for chronic kidney disease. Beyond those recommendations, coverage at work remains a key tool for ensuring safe, reliable, and affordable dialysis.
Employer-provided coverage offers widespread and generous coverage of renal dialysis and treatment services for those with ESRD and other forms of kidney disease – it's in the best interest of employees and dependents. As with other chronic health conditions, by prioritizing patient-centered, high-value care for chronic kidney disease and ESRD, health insurance providers, employers, and health care providers can facilitate care that is more affordable and results in better health.
