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.