Understanding Medicare Advantage Coverage of End-Stage Renal Disease
In addition to individuals age 65 and older and people with disabilities, Medicare covers people with End-Stage Renal Disease (ESRD), also known as kidney failure. ESRD occurs when an individual’s kidneys permanently and completely stop functioning. By 2021, all Traditional Medicare beneficiaries with ESRD will be allowed to enroll in Medicare Advantage.
In December BMA published our "Analysis of End-Stage Renal Disease Payment Adequacy in Medicare Advantage" issue brief.
Using 2018 FFS claims data to determine the average spending of ESRD patients by metropolitan statistical area (MSA), Avalere Health, which conducted the study, found that in the top 15 MSAs with the most ESRD patient enrolled in FFS, 10 had costs that exceeded the Medicare Advantage payment rate.
Based on this analysis, Medicare Advantage plans may not be adequate for ESRD patients, especially for those in populous urban eras, where many beneficiaries with ESRD reside.
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