Millions of Americans depend onhealth insurance to help paytheir medical costs. If you have

chronic kidney disease (CKD), you maydepend on health insurance even more—and worry about what will happen ifyou lose your job and your group health

insurance. Can you takea new job and get

group healthinsurance from

your new

employer? The information in thischapter will answer this importantquestion and others—and help set yourmind at ease. The next chapter hasinformation about Medicare, which, ifyou qualify, can work with your healthinsurance, and can help if you don’thave health insurance at work.

WWhhaatt yyoouurr hheeaalltthhiinnssuurraannccee wwiillll ppaayy ffoorr If you have an individual healthinsurance plan, or one through youremployer, consider talking with thehealth insurance company you boughtyour plan from, or with the person atyour job who is the contact for healthinsurance questions. (If you are worriedthat this might put your job or insurancein jeopardy, be sure to read your policyand “Protecting your right to work” onpage 15.) Ask for a detailed list ofkidney disease treatments your plancovers, such as doctors’ visits, drugs,and lab tests, and make sure the

plan will pay bills from thedoctors, dialysis centers, andother providers you use (they may have to be on the plan’s“approved list” or be “in network”).

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Will your insurance pay the full cost of these services? If not, how much willyou have to pay, including deductibles,coinsurance, and co-payments? Ask ifthere are limits on the amount the planwill pay each year and over yourlifetime. The ideal plan has unlimitedlifetime limits so you won’t lose coverage.

Compare this information with what Medicare will pay for yourmedical treatments, if you qualify (see “Medicare—for people with awork history,” on page 18).

IIff yyoouu cchhaannggee jjoobbssWhat if a great new job comes along?Will the new employer offer you healthinsurance if you have kidney disease?Will the employer’s plan pay yourkidney disease expenses? Thanks to the Health Insurance Portability andAccountability Act (HIPAA), the answercan be yes, if the new employer has atleast two current employees. If it does,you can only be denied coverage ifyou don’t already have health insurance,you’ve gone 63 days or longer withouthealth insurance, your new company’splan does not cover CKD treatment, oremployees in similar jobs are not offeredhealth insurance. If none of these condi-tions apply, you can’t be turned downfor insurance just because you have a“pre-existing condition,” CKD, and youcan’t be denied coverage for kidneydisease costs.

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IIff yyoouu ddoonn’’tt hhaavveehheeaalltthh iinnssuurraanncceeIf you need dialysis or a transplant,Medicare may pay many of your medicalcosts, but not all of them. Your socialworker can tell you about programsthat can help pay costs that Medicaredoesn’t cover, such as Medigap (Medi-care supplement plans), Medicaid (seepage 32), a health insurance programfor people with low income and limitedassets, or a state high-risk insurancepool for uninsured people. There maybe free health clinics that can providesome medical services. Many drugcompanies offer drugs free or at discountsto people who can’t afford them anddon’t have health insurance that pays fordrugs. You’ll find a list of hundreds ofthose programs on the Web site of thePartnership for Prescription Assistanceat wwwwww..ppppaarrxx..oorrgg, as well as atwwwwww..rrxxaassssiisstt..oorrgg. Chapter 7 explains anumber of additional financial resourcesfor people with kidney failure.

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you may be able to keep your healthinsurance coverage for a limited timeunder the government’s ConsolidatedOmnibus Budget Reconciliation Act(COBRA). See the table, “COBRAcoverage,” on page 16. Your cost willgo up because you will probably haveto pay the full premium, including theamount once paid by your employer.COBRA also lets you keep healthinsurance when you are between jobs,which can help you get coverage forkidney disease more quickly from anew employer. See “If you change jobs” on page 13.

Your employer must tell you how to takeadvantage of COBRA if it’s available.Although your premiums may be higher,your coverage will be the same ascurrent workers. Your premiums will bedue monthly. Family members coveredunder your plan can decide separatelyto take COBRA, so, if your spouse ordependent child has CKD, you canchoose coverage for them alone. If youare eligible for Medicare, you can stilltake advantage of COBRA, but, if yousign up for Medicare after startingCOBRA, you may lose COBRA cover-age. If you have any concerns, call theDepartment of Labor Employee BenefitsSecurity Administration (EBSA) at 1-866-444-3272. You can read thebooklet, An Employee’s Guide toHealth Benefits under COBRA, online atwwwwww..ddooll..ggoovv//eebbssaa. Click Publications/Reports and then the publication title.

You may have a waiting period beforethe new plan will pay your kidneydisease medical costs specifically, butHIPAA limits the waiting period tobetween 12 and 18 months. You mayhave met all or part of this new waitingperiod with your “creditable” healthinsurance coverage from another groupplan, Medicare, or Medicaid. You canask your new employer for informationabout HIPAA, or read about it online atwwwwww..ddooll..ggoovv//eebbssaa. Click Portability ofHealth Coverage (HIPAA). Be sure youunderstand how HIPAA applies to youbefore changing health plans. HIPAAdoesn’t apply if you want to switch fromone individual health plan to another.

Get a written certificate of creditablecoverage when you leave any healthplan. The certificate should list yourcoverage dates, policy number, insurer’sname and address, and family membersincluded under your coverage.

Many federal, state, and local agenciesprovide employee health-insuranceplans that do not have pre-existingcondition limitations.

IIff yyoouu lloossee yyoouurr jjoobbWhat happens if you lose your grouphealth insurance because you are laid off, become too ill to work, or your work hours are reduced? If yourcompany has 20 employees or more,

PPrrootteeccttiinngg yyoouurr rriigghhtt ttoo wwoorrkkIf you’re qualified for a job and can doit, you cannot be fired or turned downwhen applying just because you havekidney disease. You don’t even have to tell an employer about your illness ifit will not interfere with your ability todo the job. This protection is providedby the Americans with Disabilities Act(ADA) and all businesses with 15 ormore employees must follow this law.The ADA also requires these businessesto make changes in their jobs andworkplace to meet disabled employees’needs. Offering flexible work hours, forexample, makes it easier for anyonewith kidney disease or a transplant totake time off for medical appointments.Businesses get federal tax credits forhiring individuals with disabilities throughstate Vocational Rehabilitation agenciesor private companies called EmploymentNetworks and for making workplacechanges to accommodate them.

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If you are temporarily unable to performessential job functions as defined bythe ADA because of kidney disease,you may be eligible to take up to 12weeks of unpaid leave according to theFamily and Medical Leave Act (FMLA).FMLA applies to companies with atleast 50 full- or part-time employees.You can take the time all at once orspread over a 12-month period. If youare taking care of a parent, spouse, or child with CKD, you also can takeunpaid leave under FMLA. To learnmore, go to wwwwww..ddooll..ggoovv, click Familyand Medical Leave Act, and then FAQ. If you feel you are being treatedunfairly because you have kidneydisease, contact the Equal EmploymentOpportunity Commission (EEOC) at 1-800-669-4000 or go online towwwwww..eeeeoocc..ggoovv.

There is a program similar to COBRAfor federal government workers calledTemporary Continuation of Coverage(TCC). Ask your personnel office aboutthis program and request a copy ofTemporary Continuation of CoverageUnder the Federal Employees HealthBenefits Program, Pamphlet RI 79-27.You also can learn about TCC onlineat wwwwww..ooppmm..ggoovv. Click Quick Index,

then Federal Employees Health Benefits,and then Temporary Continuation ofCoverage.

What if your COBRA coverage runs outbefore you find a new job or you can’tget COBRA because your companydoesn’t have to offer COBRA benefits?Check out “Health insurance throughyour state” on page 16 and “If you don’thave health insurance” on page 13.

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HHeeaalltthh iinnssuurraannccee tthhrroouugghh yyoouurr ssttaattee Your state may have health insurancelaws that give people with chronicdiseases better ways to buy, change, or continue health-insurance coveragethan private insurance. One source of information on those laws is TheGeorgetown University Health PolicyInstitute’s A Consumer Guide for Getting and Keeping Health Insurance.There’s a guide for each state and the District of Columbia online at

wwwwww..hheeaalltthhiinnssuurraanncceeiinnffoo..nneett. Anothergood source is the Kaiser Family Founda-tion Web site, wwwwww..ssttaatteehheeaalltthhffaaccttss..oorrgg.Click Managed Care & Health Insuranceand then State COBRA Expansions to see a state-by-state description of programs.

You also can check with your stateinsurance department. For a state-by-state listing, visit the National Associationof Insurance Commissioners (NAIC)Web site at wwwwww..nnaaiicc..oorrgg. Click StateInsurance Web sites on the map, andthen your state. Or, call the NAIC HelpDesk at 1-816-783-8500.

If This Happens Who is Covered by COBRA How Long COBRA Lasts and How Much It Costs

You lose health You, spouse, dependent children 18 months; you pay 102% of premium, insurance because which is the employer’s portion you lost your job, or and the worker’s portion you don’t work enough hours to qualify 29 months if you’re disabled before or within

60 days of becoming eligible for COBRA; you pay 102% of premium for the first 18 months and 150% for the next 11 months

You go on Medicare Your spouse, dependent child, You could lose COBRA, but your spouse and but not you dependent child can keep coverage for up

to 36 months; you pay 102% of premium, which is the employer’s portion and the worker’s portion

Your child is no longer Young adult Up to 36 months; you pay 102% of premium, a dependent as defined which is the employer’s portion and the by your health plan worker’s portion

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“I have been on dialysis for 20years and I recommend thatpeople with kidney disease keepworking if they can. You’ll have a better quality of life if you’reworking—better than if you’rejust going to dialysis three timesa week. Working keeps your mindsharp. You might have to pushyourself some days, but you’llfeel better in the long run. I worka full-time job and my employergives me the time off I need.”

Susan KosalkoSusan Kosalko