Medicare Advantage

Soon, ESRD patients will be permitted to enroll in Medicare Advantage (MA) plans, potentially bringing major changes to ESRD care and how patients experience it. DPC lobbied Congress to change the law to permit ESRD patients the choice to elect such plans. Under current restrictions, which will end in 2021, the only dialysis patients in MA plans are those whose kidneys failed while they were already enrolled in a plan.

Congress had previously enacted many changes to Medicare managed care that made MA plans more attractive relative to fee-for-service Medicare, including an out-of-pocket maximum that is lower than the cost sharing most dialysis patients are responsible for in a year. Medicare beneficiaries in MA plans do not need to purchase Medigap insurance, which will be of particular benefit to patients in states that do not mandate Medigap issuance to under-65 Medicare beneficiaries. Premiums for MA plans average about $30/month, far less expensive than Medigap supplements.

MA plans also have a reputation for coordinating the care of patients with complex needs. An insurer that keeps such patients out of the hospital will earn more money, aligning financial incentives to avoid complications. MA plans also have more flexibility to address patients’ individual needs than the relatively rigid and siloed fee-for-service program.

It is DPC’s expectation that some Medicare Advantage issuers will build on partnerships they already have with some large dialysis organizations to coordinate patients care. We are generally optimistic in anticipating that these programs will bring greater care coordination and improved outcomes. However, we recognize that unintended consequences are possible, and there is a long and unfortunate history of managed care organizations stinting on expensive care. CMS needs to be on top of this transition, to anticipate and prevent any problems for beneficiaries. A top DPC priority in the coming years will be ensuring that this transition brings a broad selection of high-quality choices for dialysis patients, and that insurers act in good faith and do not discourage high-cost patients from choosing or staying in their plans.

Related Information

DPC’s Letter to Elizabeth Fowler, Deputy Administrator for CMMI

March 8th, 2021|Categories: Advance Patient Choice, Improve Access to Care, Increase Quality of Care, Medicare Advantage|

Ms. Elizabeth Fowler, Deputy Administrator Center for Medicare and Medicaid Innovation 2810 Lord Baltimore Drive Windsor Mill, MD 21244. Dear Ms. Fowler: We are seeking a bottom-up review of the ESRD Treatment Choice (ETC) demonstration [...]

Dialysis Patient Citizens and Consumers’ Checkbook Introduce Dialysis Plan Choice To Help Patients During Open Enrollment

November 2nd, 2020|Categories: Advance Patient Choice, Care Coordination, Medicare Advantage, Press Release|

WASHINGTON, D.C., -- Dialysis Patient Citizens (DPC) today introduced Dialysis Plan Choice, a new online tool designed in collaboration with Consumers' Checkbook for dialysis patients to quickly and easily compare their current Medicare Fee-For-Service plan [...]

DPC Comments on CMS Proposed ESRD Annual Payment Rule to Increase Dialysis Patient Quality Care

September 1st, 2020|Categories: Access to Transplant, Care Coordination, Comment Letter, Innovation, Medicaid, Medicare Advantage, Quality Incentive Program, Treatment Options|

Each year—typically during the summer—the Centers for Medicare and Medicaid Services (CMS) puts out rules for how they are going to pay for dialysis treatment. The rules reflect CMS’ latest policies, and organizations have [...]

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