Abstract: TH-PO813

Trends in Insurance Coverage among ESRD Medicare Beneficiaries

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Dahlerus, Claudia, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Wheeler, John, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Messana, J. M., University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Stephen, John, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Shearon, Tempie H., University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Li, Yi, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
Background

The 2010 Patient Protection Affordable Care Act (ACA) reduced the number of uninsured in the U.S. general population. Most ESRD patients are eligible for and covered by Medicare; however, it is unclear how implementation of the ACA impacted insurance status for ESRD Medicare beneficiaries. The ACA increased access to Medicaid for more people and made it possible for more people to purchase private health insurance. This potentially resulted in an increase in patients with Medicare/Medicaid Dual Eligibility (DE) coverage. Our objective is to examine whether there were changes in insurance status of ESRD dialysis patients in the initial period following ACA implementation.

Methods

Administrative data (Medicare claims files and Medicare Enrollment Data Base for 2012-2015) were used to classify ESRD dialysis patients by whether they were covered by both Medicare and Medicaid (Medicare/Medicaid DE). Trends were examined for coverage changes.

Results

From 2012-2015, there was an increase of 9.7% in the number of patients with ESRD eligible for Medicare. Over this period, the number of DE patients increased by 14.9%. Therefore, the percentage of Medicare ESRD patients with DE rose steadily from 39% to 41%.

Conclusion

The ACA extended Medicaid eligibility to more people in states choosing to participate in the Medicaid expansion. As a result, the trend in growth of persons with Medicare-Medicaid dual eligibility exceeded that of the overall Medicare ESRD population. This aspect of the ACA may therefore have improved access to dialysis care for more relatively low income people, by enabling them to afford the coinsurance and deductibles of the Medicare ESRD Program.

Number of ESRD Beneficiaries by Insurance Coverage and Year
     % Change
Insurance Coverage20122013201420152012-2015
Medicare/Medicaid Dual Eligible165,796168,770182,949190,54914.9%
All Medicare422,609436,358449,611463,5689.7%

Funding

  • Other U.S. Government Support