Many potential kidney donors worry about their health insurance coverage or premiums changing because they become a living kidney donor. In the past, this was a concern because health insurance companies could deny you coverage or charge you more for the same insurance if you had a “pre-existing condition”, meaning that you weren’t 100% healthy. 39% of centers said that they had eligible donors decline to donate because they were worried about future health insurance problems1.
Are these worries justified? Will I have trouble getting health insurance if I donate a kidney?
When over 1,000 people who donated a kidney between 1970 and 2011 were asked if they had any difficulty getting health insurance, 7% of those who changed insurance reported getting denied insurance, charged a higher premium, and/or told they had a pre-existing condition. However, some living kidney donors reported that they were given preferred status or a “low-risk” rate because they were “healthy enough to be a donor”2. It is clear that, in the past, some health insurance companies treated living kidney donor patients differently.
Since the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, it is illegal for a health insurance company to treat people differently if they have a pre-existing health condition. You should not be told that being a living kidney donor affects your ability to buy health insurance or the rate that you receive. If you have any concerns or questions, you should talk to your transplant center. Your transplant center might be able to write a letter of support to your health insurance company for you.
Since the health care laws in the United States – including the protections for Americans with “pre-existing conditions” – might change, it is best to talk to the team at your transplant center about the current healthcare laws and how they might affect you.
What if I don’t have health insurance when I donate a kidney?
We encourage all living kidney donors to have health insurance, if possible. Again, it is illegal for a health insurance company to deny you coverage or charge you a higher rate because you are a living kidney donor. If you have trouble obtaining health insurance, you should talk to the social worker at your transplant center. From 2004-2015, 16% of living kidney donors were uninsured, although this number has been decreasing over time3. While many donors have chosen not to buy health insurance in the past because they are so healthy, we know that uninsured donors are less likely to go to follow-up appointments 3, 4. It is important that all living kidney donors get annual check-ups so that they stay healthy and protect their remaining kidney.
Does the Affordable Care Act also regulate life insurance rates?
No. Unlike with health insurance, life insurance companies are allowed to deny you coverage or charge you a higher rate if they believe that you have a pre-existing condition. In the past, donors have had varied experiences with buying life insurance policies after kidney donation.
When a thousand people who donated a kidney between 1970 and 2011 were asked about life insurance, 25% of those who tried to change policies or start a new policy said they were denied, charged a higher premium, or told they had a pre-existing condition. Most of the donors who reported problems donated from 1970-1994, but some more recent donors also experienced problems. If you have concerns or questions about obtaining life insurance, you should talk to your transplant center. They may be able to write a letter of support that you can send to your life insurance company, which will inform them of the excellent health and longevity of living kidney donors.
- NATCO. Living donor health care coverage, insurability, and follow-up position statement. In. http://www.natco1.org/Advocacy/files/Living%20Donor%20Insurability.pdf: NATCO, 2006.
- Boyarsky BJ, Massie AB, Alejo JL, Van Arendonk KJ, Wildonger S, Garonzik-Wang JM et al. Experiences Obtaining Insurance After Live Kidney Donation. American Journal of Transplantation 2014;14(9):2168-2172.
- Rodrigue JR, Fleishman A. Health Insurance Trends in United States Living Kidney Donors (2004 to 2015). American Journal of Transplantation 2016:n/a-n/a.
- Gibney EM, Doshi MD, Hartmann EL, Parikh CR, Garg AX. Health Insurance Status of US Living Kidney Donors. Clinical Journal of the American Society of Nephrology 2010;5(5):912-916.