Understanding Healthcare Coverage for Kidney Surgery Under the Affordable Care Act (ACA)

The Affordable Care Act (ACA) has significantly expanded access to comprehensive health insurance coverage, including coverage for essential health benefits like kidney surgery. Under the ACA, all private health insurance plans sold in the United States are required to cover a minimum set of “essential health benefits,” which include hospitalization, outpatient surgery, and kidney dialysis. Kidney surgery is specifically included as an essential health benefit, meaning that all ACA-compliant health insurance plans must cover this service.

Out-of-Pocket Costs

While ACA health insurance plans are required to cover kidney surgery, you may still be responsible for some out-of-pocket costs, such as deductibles, co-payments, and coinsurance. A deductible is the amount you must pay out-of-pocket before your insurance begins to cover the cost of your care. A co-payment is a fixed amount you pay for each medical service, such as a doctor’s visit or surgery. Coinsurance is a percentage of the cost of your care that you are responsible for paying, after you have met your deductible.

The specific out-of-pocket costs you will be responsible for will depend on your specific health insurance plan and the type of kidney surgery you undergo. Your health insurance provider can provide you with an estimate of your out-of-pocket costs before you undergo surgery.

Accessing Care

If you need kidney surgery, you should contact your health insurance provider to find out which doctors and hospitals are in-network. In-network providers have contracted with your insurance company to provide services at a discounted rate. Using an in-network provider will help you save money on your out-of-pocket costs.

You can also use the ACA’s online marketplace, HealthCare.gov, to find health insurance plans and providers in your area. HealthCare.gov provides a variety of tools to help you compare plans and find the one that’s right for you.

Additional Resources

For more information about ACA health insurance coverage, please visit the following resources:

[HealthCare.gov](https://www.healthcare.gov/)
[National Health Law Program](https://www.nhelp.org/)
[Kaiser Family Foundation](https://www.kff.org/)