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Kidney Week

Abstract: SA-PO050

Switchers from Medicare Fee-for-Service Program to Medicare Advantage Early 2021 Among ESKD Patients

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Liu, Jiannong, Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Wetmore, James B., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
  • Johansen, Kirsten L., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

Before 2021, Medicare beneficiaries with end-stage kidney disease (ESKD) were not permitted to switch from traditional Medicare (Medicare fee-for-service, MFFS) to Medicare Advantage (MA). However, starting in January 2021, beneficiaries were eligible to switch to MA, thanks to the 21st Century Cures Act. Using the United States Renal Data System, we examined differences between beneficiaries who continued with MFFS and those who switched to MA.

Methods

Adults (aged≥18 years) on dialysis or with a kidney transplant (ktx), with MFFS as primary payor, as of December 2020 were assessed for their Medicare coverage in January 2021.

Results

In total, 412,769 patients (pts) were included; 315,015 receiving dialysis and 97,754 with a ktx. Among dialysis pts, 11.5% switched from MFFS to MA (9.6% among home dialysis pts, 11.8% among in-center dialysis pts); 5.4% among Ktx pts. Those who switched were younger (median age for dialysis pts, switcher vs non-switcher: 61.3 vs 65.6 years; for those with a ktx, 62.4 vs 63.6). Pts who switched were also more likely to be non-Hispanic (NP)-Black or Hispanic (dialysis pts, NP-Black: 47.9% vs 32.7%; Hispanic, 17.8% vs 15.3%; ktx recipients, NP-Black, 37.3% vs 21.6%, Hispanic, 15.8% vs14.1%); and more likely to have dual Medicare and Medicaid coverage (dialysis, 51.7% vs 43.8%; ktx, 35.7% vs 29.1%). Those who switched were also more likely to have diabetes or hypertension as their cause of ESKD (Table).

Conclusion

In 2021, more than one tenth of pts with ESKD switched from MFFS to MA; switching was associated with age, race/ethnicity, and Medicaid enrollment. This shift alters the generalizability of the MFFS population with ESKD, and heightens the need for monitoring of outcomes among patients enrolled in MA.

Funding

  • NIDDK Support