Blog Post

Are Medicare Advantage Plans Ready for ESRD Patients?


Medicare Advantage open enrollment season has begun (as of October 15), as the options for expanded coverage continue to increase considerably.  To that point, at Healthmap Solutions, we are watching and have prepared for a significant change in coverage as a result of the 2016 CURES Act, which opens up coverage for chronic diseases such as treatment for End-Stage Renal Disease (ESRD).

Even though the actual coverage doesn’t start until 2021, it will become available in next season’s open enrollment period, which means Medicare Advantage Plans should be considering ways right now to serve CKD populations in order to be in a position to offer these complex expanded benefits in time.  As our Medicare Advantage Plan partners know, preparing well in advance for an influx of members – particularly populations with complex health conditions – is essential for delivering service excellence and managing their growing ESRD populations.

For instance, currently, Medicare Advantage accounts for 36% of enrollment, but is growing by 8% each year and could be the dominant form of Medicare by 2025.  With 2021 around the corner, that means a very likely influx of CKD patients and others with complex chronic conditions.  Check out this consumer-focused article in Forbes [link at the end of this post] about open enrollment and expanding benefits, which also spotlights the special challenges facing Medicare Advantage Plans … here are a couple of excerpts:

“In 2020, many Medicare Advantage plans will be further expanding these supplemental benefits, adding transportation, over-the-counter medication, educational programs and supportive services for those with chronic illnesses, and home improvements that ensure beneficiaries’ safety.”

“In keeping with a continued emphasis on value-based care, these new supplemental benefit offerings reflect Medicare’s ongoing efforts to reduce hospital readmissions and enable seniors to stay healthy at home instead of in a medical facility.”

That last point ties well with Healthmap’s own belief that at-home dialysis treatment is much better than forcing a patient into in-facility dialysis, something that Medicare Advantage Plans will need to plan for, and is being addressed in the interim by a Presidential Executive Order announced this past July [read more here].

Contact Us for more information about the CURES Act and how Healthmap Solutions is helping Medicare Advantage Plans prepare.

Click here for the Forbes article.