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 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 [...]

DPC’s 2020 Annual Membership Survey is Live!

August 6th, 2020|Categories: 5-Star Ratings, Access to Transplant, Article, Care Coordination, Charitable Premium Assistance, Dental Coverage, Dialysis Funding, Get Involved, Immunosuppressive Drug Coverage, Innovation, Medicaid, Medicare Advantage, Medigap Coverage, Quality Incentive Program, Take Action, Transplant Donor Protection, Transportation Services, Treatment Options|Tags: |

Elevate the Voice of Patients with Kidney Disease and Their Caregivers Our 2020 Annual Membership Survey is live, and it will remain open until Friday, August 21. We are counting on your participation, as [...]

Dialysis Patient Citizens Files Lawsuit Against HHS Secretary Alex Azar and CMS Administrator Seema Verma Over New Regulation That Undercuts Dialysis Patient Access to Affordable, High-Quality Care

June 22nd, 2020|Categories: Care Coordination, Legal Defense, Medicare Advantage, News, Press Release|

WASHINGTON, D.C., (June 22, 2020) -- Today, Dialysis Patient Citizens (DPC) filed suit in the United States District Court for the District of Columbia against Health and Human Services Secretary Alex Azar, Centers for [...]

More Related Information

Learn More About Promoting Financial Security

Rearview studio shot of a diverse group of young people embracing each other against a gray background

Charitable Premium Assistance

Medigap Coverage

Senior Woman Being Hugged By Adult Son In Garden

Medicare Advantage

Shot of a happy senior woman spending quality time with her daughter outdoors

Medicaid