KCP: ease restrictions for ESRD patients wanting to join MA plans

July 7, 2015

Published by Nephrology News & Issues
July 7, 2015

Restrictions should be lifted for new Medicare patients wanting to enroll in Medicare Advantage plans after being diagnosed with kidney failure, Kidney Care Partners wrote in a recent letter to Congress.

Currently, Medicare beneficiaries in fee-for-service plans who develop end-stage renal disease cannot join in an MA plan as a new enrollee. However, if an individual already in an MA plan develops ESRD, that individual is able to maintain his/her current plan. Additionally, an MA enrollee with ESRD who has his/her plan terminated has a one-time right to choose another MA plan. That beneficiary can opt into another MA plan immediately, or he/she can also be placed back into a fee-for-service plan and still have a one-time right to enroll in an MA plan later.

“The argument that plans do not have the ability to adequately care for ESRD patients is simply not supported by the facts,” wrote KCP, citing Medicare Payment Advisory Commission data that about 14% of ESRD beneficiaries were enrolled in MA plans in 2013. “The highly coordinated care provided by MA plans can lead to improved health outcomes for ESRD patients with complex medical conditions. Additionally, access to MA plans for these beneficiaries could alleviate some financial hardships faced by these populations. Many Medicare ESRD beneficiaries are under the age of 65, and in most states these beneficiaries do not have the option of purchasing a Medicare Supplemental Insurance Policy (Medigap) to help defray the cost of co-pays and cost sharing, which can be significant. Many MA plans offer reduced cost sharing, which would be an invaluable benefit for ESRD beneficiaries,” KCP wrote.

The kidney community advocacy group added that Congress has already acknowledged the benefits of MA plans for dialysis patients. “The Conference report accompanying the Balanced Budget Refinement Act of 1999 states, ‘the parties to the agreement also believe Medicare enrollees with ESRD could benefit by being offered the opportunity to enroll in Medicare+Choice plans,’ “ KCP wrote. In 2000, MedPAC recommended removing the prohibition of MA as a choice for ESRD beneficiaries.

The KCP letter was sent to members of the Senate Finance Committee in response to their review of S. 598, the Chronic Kidney Disease Improvement in Research and Treatment Act, which focuses on research and improving treatment for individuals with kidney disease. Tomorrow: KCP comments on a proposed voluntary ESRD care coordination program and reauthorization Special Needs Plans.

See the original article on the Nephrology News & Issues website.