Maintaining

employment and
insurance on dialysis

Learn more about dialysis

and chronic kidney disease www.davita.com
© 2008 DaVita Inc. All rights reserved. DCOM-3450
Maintaining
employment and
insurance on dialysis

In addition to health concerns,

Employment and 03
people with kidney disease who 1 health benefits
need dialysis treatment may also
have financial concerns. This book 2 Your work rights 05
provides information about keeping
your job and health benefits, makes 3 Avoiding disability 07
you aware of laws that protect your
work rights and gives you a list of
4 Paying for treatment 08
resources that may help you pay for
kidney disease treatments.
5 Medicare basics 10

Resources 12
6

www.davita.com
 Maintaining employment and
insurance on dialysis

1
Employment and With any chronic illness, you can
expect to get bills from doctors,
health benefits hospitals, laboratories and
pharmacies. Having a good health
Employment and insurance benefits plan and understanding
information for chronic kidney your benefit coverage can reduce
your out-of-pocket expenses and
disease (CKD) patients
assure you the widest range of
treatment choices. Health insurance
Our goal at DaVita is to help keep
is complex and changes to your
your life with CKD as normal as
insurance may have a substantial
possible and to make sure you
impact on how your treatment is
receive all of the available benefits
paid. DaVita Social Workers and
for treatment. We know that keeping
Guest Services Specialists (GSS) can
your job and your health insurance
help. Contact DaVita GSS whenever
play an important part in making
you plan to change your job or health
this happen. So that you feel more
insurance, reduce your work hours or
in control, it is important for you to
discontinue working.
stay updated on changes to your
insurance and how federal and
You may be told by different people
state policy and regulation changes
(e.g., transplant teams, Medicare/
affect your employer health benefits,
Medicaid offices and discharge
COBRA, Medicare and Medicaid
planners) that you should elect
policies. This information will help
Medicare or other coverage. DaVita
you know your rights and be able
GSS can help answer your questions,
to make informed decisions about
look at work options, review financial
employment and insurance.
assistance options and ensure
you receive the maximum amount
For information on financial and
of coverage through your health
insurance concerns, call DaVita
insurance plan. We want our patients
Guest Services at 1-800-244-0680.
to have all the facts before making
decisions regarding changes to their
Having a good health benefits benefits.
plan and understanding your
benefit coverage can reduce
your out-of-pocket expenses
and assure you the widest range
of treatment choices.

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 Maintaining employment and
insurance on dialysis

Keeping your job and health

benefits is the best way to keep
your life as normal as possible
and to pay for your kidney
disease treatment.
Stay Healthy
When you have kidney disease, you
can continue to work by taking care
of yourself. One of the best ways to
do this is to follow the advice of your
physician and health care team.
• Take medicines as directed.
• Tell your physician or nurse if you
feel sick or tired.
• Eat a healthy diet.
• Make healthy lifestyle choices.
Rest and exercise to help you feel
better and have more energy.

Choose a Work-friendly Treatment

When you start dialysis, choose a
treatment that fits with your work
schedule.
• Peritoneal dialysis (PD) is flexible
— as long as you fit in your
exchanges as prescribed. People
who can use a cycler are able
to do their exchanges at night,
while they sleep.
• Home hemodialysis (HHD) lets you
choose when you do dialysis. This
choice is not offered in all facilities.
• If you choose in-center
hemodialysis, ask to schedule your
treatments around your work.

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 Maintaining employment and
insurance on dialysis

2 Your work rights these changes and discuss them

with your Social Worker and
DaVita GSS:
o Decreased work hours
Changes in your employment o Termination
status can signal changes in (self- or employer-initiated)
your health care insurance. o Layoff

Know Your Work Options Companies need workers who come

You may not feel well when first on time and do their jobs well. If you
starting dialysis, but many people will start treatment soon or are on
find that after getting used to the dialysis now, you may need to miss
treatments, they feel well enough to some work time. Ask your boss for
keep working full- or part-time. time off as soon as you know you
• If you are too ill to work, take a need it, and talk with your human
temporary leave of absence resources department to determine
instead of quitting. exactly what benefits are available
• Talk to your employer about to you. You can keep your job when
working part-time or flexible hours you have kidney disease. The U.S.
to keep your benefits. government identifies kidney failure
• By keeping your job, you will have as a disability even if you continue
more flexibility financially than if to work. So, there are laws that
you stopped working. protect you from workplace bias due
• By continuing to work, you can to illness.
keep your health benefits, which
cover treatments and medicines. The Rehabilitation Act of 1973
• If you must leave work, ask if The Act protects people who work
you are eligible for COBRA. for the U.S. government. It bans
COBRA would allow you to discrimination due to illness against
continue your company benefits those employed by the executive
for at least 18 months. Talk to your branch of government, by federal
Social Worker and DaVita Guest contractors and by anyone who
Services Specialist (GSS) about receives federal funds. Each federal
how you can pay for the COBRA agency enforces its own rules.
premiums and other out-of-pocket Call the Department of Justice at
medical expenses. 1-800-514-0301 to file a complaint.
• Changes in your employment
status can signal changes in your
health care insurance. Be aware of

5
 Maintaining employment and
insurance on dialysis

to return to work. Your employer

Americans with Disabilities
Act of 1990
If you work for a company with at
least 15 employees and ask for a
reasonable accommodation to do
the essential functions of your job,
your employer must agree, unless the
requested accommodation causes an
undue burden. If you interview for a
new job, someone can ask you if you
need a reasonable accommodation
to perform the essential functions of
the job, but no one can ask whether
you have a disability and what that
disability is. Learn more at the EEOC
website, http://www.eeoc.gov.
may require, or you may request, to
substitute vacation time for unpaid
leave. Contact the U.S. Department of
Labor, Frances Perkins Building, 200
Constitution Avenue NW, Washington,
D.C. 20210. Or call 1-866-4-USWAGE
(TTY 1-877-889-5627).
Other Laws
State laws may protect you from
bias. Find out who to call about your
state’s antidiscrimination laws at
www.dol.gov/odep/state/state.htm.

You can keep your job when you

have kidney disease.
Another organization, the Disability
Rights, Education and Defense
League, offers attorney referrals and
information on the ADA. Contact
them at 1-800-348-4232 or
www.dredf.org.

Family and Medical Leave Act of 1993

If you’ve worked long enough for a
company with at least 50 employees
within a 75-mile radius, you may
qualify to take 12 weeks of unpaid
FMLA leave within a 12-month period
for certain reasons. Your employer
can’t penalize you for taking leave,
but may ask you for a doctor’s release

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 Maintaining employment and
insurance on dialysis
3 Avoiding disability
As a kidney patient, you may
worry that you are going to be
disabled. DaVita wants to help
you learn how to stay healthy
and avoid disability.
Stay Fit
Staying active is key for you to feel
your best. Kidney disease reduces
blood flow to your muscles—and
exercise can help bring it back. Talk
with your doctor about what type of
activity is right for you. Examples can
include walking, biking, weightlifting
or swimming. Yoga may be an option
to help relieve stress and increase
flexibility. Follow your doctor’s
recommendations and start slowly,
building up gradually. You will be glad
you did.
Working
In the U.S., many of us spend almost
as much time at work as we do
at home. Working and talking to
co-workers can help to keep your
mind focused on things besides
your health. For many of us, our co-
workers are part of our family and can
give us strength and support.
Deal with Health Setbacks
Health setbacks can happen with
any chronic illness. It is important
for you to know your company’s sick
leave policy. If you need to take an
extended sick leave, remember
the Family and Medical Leave Act
(FMLA).
Know Where to Get Help
If you cannot keep your current job
even with workplace changes, think
about your other choices. If you
can, move to another job in your
company so you can keep your health
insurance, sick leave, vacation and
seniority. If not, you have job skills
and experience. Update your résumé
and use a state or private vocational
rehabilitation counselor and/or the
Internet to find another job.
Look for companies large enough to
be covered under the Americans with
Disabilities Act and Family Medical
Leave Act. Remember that a potential
employer can only ask you if you
need a reasonable accommodation to
perform the essential functions of the
job. If you do not need any special
arrangements or changes, you
do not have to talk about your
kidney disease.
Could you work for yourself? The
Small Business Administration and
Senior Corps of Retired Executives
can help you write a business plan
and find funds.
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 Maintaining employment and
insurance on dialysis
While disability payments are
a safety net, they may not
be enough to pay your bills.
Most people on disability must
change their lifestyle.
Understand Disability
If you continue to be too ill to keep
working, you can apply for Social
Security Disability Insurance (SSDI).
You will have to wait to become
eligible for SSDI for at least six
months. Supplemental Security
Income (SSI) may be available to you
if you have little or no work history
and have little income or savings.
While disability payments are a safety
net, they may not be enough to pay
your bills. Most people on disability
must change their lifestyle.
If you’re on SSI or SSDI and feel
healthy enough to return to work,
there are work incentives that may
assist you. These can help you ease
back into work, without losing your
disability benefits right away. Ask the
Social Security Administration (SSA)
about disability and work incentives.
4 Paying for
treatment
Many people with kidney
disease worry about how they
will pay for treatment. There are
many sources of coverage.
Employer Health Insurance
Health insurance through an employer
often provides better benefits than
any state or federal program. The
Health Insurance Portability and
Accountability Act (HIPAA) may help
you and your family get other health
insurance if you change jobs or lose
your insurance. Neither you nor your
dependents can be denied coverage
or should have to wait for treatment
due to pre-existing health conditions
under HIPAA. You cannot use HIPAA
to get other coverage if you have
Medicare or Medicaid—but your
family may.
Contact: 1-800-MEDICARE for the
booklet Protecting Your Health
Insurance Coverage (CMS-10199).
Your DaVita Guest Services
Specialist can help you
understand your insurance
choices.
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 Maintaining employment and
insurance on dialysis
COBRA
If you or your spouse is working
and has employer health insurance
but will be losing that coverage
through termination, discontinuing
employment, reduced work hours
or layoff, you may be eligible to buy
group coverage for you and your
family for a limited time.
If you are entitled to COBRA benefits,
your health plan must give you a
notice stating your right to choose
to continue benefits offered by the
plan. COBRA is your same health
insurance coverage, but at a higher
cost. COBRA beneficiaries are
generally eligible for coverage for 18
months, but this can be extended in
some instances. Depending on the
employer’s insurance policy, if you
become entitled to Medicare benefits
before you elect to receive COBRA,
then you will be able to carry both
policies. However, if you have group
health insurance under COBRA and
then become entitled to Medicare,
your COBRA policy may terminate.
If you are qualified, you have 60
days to elect coverage and then 45
days to pay the initial premium for
the COBRA coverage. Your DaVita
Guest Services Specialist can help you
understand your choices.
Medicare
Medicare is a federal program run
by Social Security for people who
are elderly, disabled or have kidney
failure. We will talk about this in more
detail in the next section.
Medicaid
Medicaid is state-funded medical
assistance. You may qualify for
Medicaid if you are 65 or older,
disabled or have dependent
children, and have little income or
savings. Medicaid covers services
such as hospital charges, doctor
fees, prescription medicines and
transportation. Each state has
different rules about what is covered,
so you will need to learn about the
rules where you live by contacting
your state welfare office.
Medigap (Medicare Supplement)
Some insurance companies sell plans
to cover all or part of what Medicare
does not pay. States have different
plans to choose from, with varying
benefits and cost. People who are
at least 65 and apply in the first six
months of having Medicare can’t be
denied or made to wait for coverage
because of kidney disease. If you are
under 65, your state may allow you to
buy Medigap coverage.
Call your state insurance commission
to learn which Medigap plans are
available and whether you are eligible.
Contact: 1-800-MEDICARE for the
booklet Choosing a Medigap Policy
(CMS 02110).
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 Maintaining employment and
insurance on dialysis
Veterans’ Benefits
Some veterans get dialysis at VA
hospitals, while others go to dialysis
facilities where the VA may pay all
or part of the cost. Veterans may be
able to get medicines for a small fee.
Contact: http://www1.va.gov/health/
index.asp.
Indian Health Service (IHS)
The IHS may pay for dialysis for
Native Americans and Alaska Natives
who live on or near reservations and
who don’t have any other coverage.
State Kidney Programs
Your state may have a program to
help people with kidney disease pay
for dialysis, drugs and transportation.
Programs vary from state to state
and year to year. Your DaVita Social
Worker or Guest Services Specialist
(GSS) can tell you if your state has a
state kidney program.
American Kidney Fund (AKF)
AKF assistance is for patients on
dialysis. AKF may be able to assist
with paying for COBRA benefits,
employer plan premiums and
Medicare Part B premiums. Your
Social Worker and DaVita Guest
Services Specialist can tell you more
about AKF.
5 Medicare basics
Medicare is available to most
people in the U.S. This is a
special insurance program for
people who are 65 years or
older, on disability for two years
or have kidney failure. If you
have kidney failure, Medicare
will pay for covered medical
expenses, but it is important
for you to know that Medicare
only pays for 80% of the cost.
You will need a way to pay for
the 20% of cost that Medicare
doesn’t cover. Medicare is
run by the Social Security
Administration and you need to
sign up by phone or mail—
it’s not automatic. There are
two parts:
Part A
Pays for hospitalizations including
hospital stays, skilled nursing facilities,
hospice and rehabilitation facilities.
Most people get Part A for free. You
pay a deductible for inpatient hospital
stays, inpatient blood transfusions
and kidney transplant costs.
Part B
Pays for medical expenses including
doctor fees and most other
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 Maintaining employment and
insurance on dialysis
outpatient charges, including dialysis.
You pay an annual deductible, a
monthly premium, as well as the 20%
of charges not covered by Medicare.
Eligibility. People who are 65
years or older, have received
Social Security disability checks
for two years or have kidney
failure can get Medicare.
If you choose home dialysis,
Medicare will pay for your
treatment right away, including
the training you need.
When Medicare Starts and Ends
If you or your spouse is working
and has health insurance through an
employer, there is a coordination of
benefits period. (Please see the next
section for more information.) If you
choose home dialysis (peritoneal
dialysis or home hemodialysis),
Medicare will pay for your treatment
right away, including the training you
need. If you choose in-center dialysis
(hemodialysis), Medicare won’t start
to pay until the first day of your
fourth month of treatment.
Medicare can help pay for a transplant
and may even cover some of the
testing before you get a transplant.
Medicare will end 36 months after a
transplant unless you have another
disability or are at least 65. If you stop
dialysis, Medicare will end coverage
after 12 months unless you have
another qualifying condition.
Coordination of Benefits
When you, your spouse or parents
have health insurance through an
employer, that insurance is generally
primary for 30 months based on
patient’s Medicare entitlement date.
During this time, Medicare provides
secondary coverage and can be billed
Medicare-allowable charges that your
employer insurance doesn’t pay in full.
After 30 months and with enrollment
in Medicare, Medicare becomes
primary, and your employer insurance
is secondary and may pay for some or
all of the expenses Medicare doesn’t
cover.
When to Enroll in Medicare
If you already have health coverage
through your employer, a retirement
plan, COBRA and/or an individual
plan, you should consult your Social
Worker or DaVita Guest Services
Specialist prior to electing Medicare.
When enrolling in Medicare, sign up
for both parts A and B at the same
time.
Medicare and Medicines
Medicare pays for only a few drugs.
Most of these are injected at a clinic,
such as anemia medicine (EPO),
vitamin D and some antibiotics.
Medicare also pays for some
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 Maintaining employment and
insurance on dialysis
transplant drugs for 36 months after a
transplant. Since 2006, Medicare has
paid part of your drug costs. There
are also Medicare approved discount
drug cards and programs from drug
makers that help some people afford
prescribed medicines.
6 Resources
At DaVita, we have a strong
commitment to helping you
keep your life as normal as it can
be. Let your Social Worker or
DaVita Guest Services Specialist
know if you have concerns
about continuing to work or
being able to pay for treatment.
Other resources to consider
include the following:
DaVita Insurance Consultation
1-800-244-0680 or www.davita.com
Contact DaVita and speak with an
insurance specialist at no charge.
Human Resources Department
If you have an employer-based
health plan or COBRA, it is important
to know and discuss your current
benefits with your company’s
human resources department on a
regular basis.
National Kidney Foundation (NKF)
1-800-622-9010 or www.kidney.org
Available materials: Working with
Kidney Disease: Rehabilitation
and Employment (NKF-#05-03R);
Financial Resources for Kidney
Patients (NKF-#05-39)
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 Maintaining employment and
insurance on dialysis

Medicare
1-800-MEDICARE
or www.medicare.gov
Available materials: Medicare
Coverage of Kidney Dialysis and
Kidney Transplant Services:
A Supplement to Your Medicare
Handbook #10128
(Large Print: #10128-LE)

Social Security Administration

w or www.ssa.gov/pubs/
Available materials: Medicare
(#05-10043); Social Security: Basic
Facts (#05-10080); Social Security:
Understanding the Benefits (#05-
10024) and Working While Disabled—
How We Can Help (#05-10095)

Small Business Administration

www.sba.gov

Senior Corps of Retired Executives

www.score.org

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