Fact Sheet

Preparing for End-Stage Renal Disease 2021 Enrollment into Medicare Advantage by Addressing Payment Adequacy 

Currently, most beneficiaries with ESRD receive coverage through Traditional FFS Medicare, however some can enroll in Medicare Advantage under limited circumstances. Beneficiaries who develop ESRD while enrolled in a Medicare Advantage plan can retain their coverage. However, payments to Medicare Advantage for ESRD patients are set at the state level rather than the county level. As a result, ESRD payments do not consider cost variation within a state. Additionally, ESRD risk adjustment for Medicare Advantage plans is based on a separate model from the one used for other Medicare Advantage enrollees.