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Kidney Week

Abstract: PO2489

Demonstrating Charitable Premium Assistance as a Mechanism for Overcoming the Cost Barrier to Transplant for Low-Income Patients in the United States

Session Information

Category: Transplantation

  • 1901 Transplantation: Basic


  • Spigler, Michael, American Kidney Fund, Rockville, Maryland, United States
  • Bello, Morenike, American Kidney Fund, Rockville, Maryland, United States
  • Paris, Melanie, American Kidney Fund, Rockville, Maryland, United States
  • Vo, Lisa, American Kidney Fund, Rockville, Maryland, United States
  • Norman, Silas, University of Michigan Transplant Center, Ann Arbor, Michigan, United States

The optimal treatment for patients with end-stage renal disease (ESRD) is kidney transplantation. Adequate insurance coverage is one requirement for transplant eligibility. Many low-income ESRD patients cannot afford insurance coverage. Patients on dialysis are eligible for Medicare. Because Medicare covers only 80% of healthcare costs, most patients require supplemental insurance, often Medigap. Although Medigap plans reduce out-of-pocket spending on healthcare services by almost 50%, spending on health insurance premiums more than doubles compared to Medicare premiums alone. For low-income patients who cannot afford such premiums, inadequate insurance coverage can become an insurmountable barrier to qualifying for a kidney transplant (KT). We evaluated a premium assistance program designed to help low-income ESRD patients maintain insurance coverage and the impact on KT access.


We performed a descriptive analysis of self-reported patient data collected from paper and digital applications submitted to American Kidney Fund’s (AKF) Health Insurance Premium Program (HIPP) between November 15, 2018 and December 31, 2019.


HIPP provided financial assistance grants to 1,357 (5.8% of all) kidney patients transplanted in the United States during the study period so they could maintain their health coverage in 2019. Of the 1,357 grants, 36% of grants issued helped patients pay Medigap premiums. Medigap recipients were more likely to be ≥ 65 (20% vs. 12%), more likely to be African American (38% vs. 34%), and had lower median income ($23,622 vs. $27,168 respectively) compared to the overall transplant population.


KT candidates face financial barriers to transplantation. Premium assistance significantly reduced the barrier to transplant among KT candidates who rely on Medigap by ensuring adequate coverage.