Although the Medicare program is designed to provide health care for persons 65 and older, a person of any age who suffers from end-stage renal disease that requires dialysis or a kidney transplant is also covered by Medicare. Because Medicare requires premiums, deductibles and co-payments for its covered services, supplemental health care insurance coverage or other programs are often needed to meet these Medicare-related payments. For children suffering from end-stage renal disease, there are programs that provide supplement Medicare coverage.
Medicare Coverage For ESRD
Children suffering from end-stage renal disease qualify for Medicare Part A, which covers hospital expenses, and Part B, which covers outpatient medical services; however, the benefits are limited. Generally, Medicare Part A benefits require paying a yearly deductible. Medicare Part B services require a deductible, a 20 percent coinsurance payment and a monthly premium. A Medicare supplement insurance plan---often called a Medigap policy---is needed to cover deductibles and coinsurance payment required by Medicare.
Medigap Policy
Federal law mandates that insurance companies sell Medigap policies to Medicare beneficiaries older than 65 and prohibits the use of underwriting criteria, such as pre-existing conditions. However, no such mandate applies regarding Medicare beneficiaries younger than 65 who are end-stage renal disease sufferers. Whether or not Medigap policies are available for children suffering from end-stage renal disease depends upon state law.
For example, only Delaware mandates that insurers offer Medigap policies to end-stage renal disease sufferers younger than 65. Although Vermont, Massachusetts and California mandate Medigap policies for disabled persons younger than 65, end-stage renal disease sufferers are excluded from this mandate. Insurers can voluntarily offer Medigap policies to young end-stage renal disease sufferers; however, because the insurer can use underwriting criteria in these situations, the premiums for these policies can be higher than the same coverage for a Medicare beneficiary older than 65.
State Health Insurance Counseling and Assistance Programs
Given that the Medigap policies for children suffering from end-stage renal disease vary from state to state, the best source of information on Medigap policies for young end-stage renal disease sufferers is the State Health Insurance Counseling and Assistance Program available in every state. All Medicare-related questions, including questions about the availability and coverage provided by Medigap plans, are handled through a State Health Insurance Counseling and Assistance Program. The official Medicare website provides links for all State Health Insurance Counseling and Assistance Program websites.
Medicaid
For children whose families have low income and limited resources, Medicaid may be available to supplement Medicare coverage. Unlike Medicare coverage which is available because the child's is suffering from end-stage renal disease, Medicaid coverage is available solely because of the child's financial need. Medicaid guidelines are set by the federal government, but each state runs its own Medicaid program. The only way to determine whether Medicaid can supplement Medicare coverage is to submit an application with the state's Medicaid office.
Children's Health Insurance Program
For families whose income is too high to qualify for Medicaid, the Children's Health Insurance Program is another program that can supplement Medicare coverage. As with Medicaid, the guidelines are set by the federal government with each state running its own program. For information regarding Children's Health Insurance Program in your state, as well as all insurance options for children, the federal government website Insure Kids Now.gov is a good resource.
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