New Insurance Options Become Available for ESRD Patients

New Insurance Options Become Available for ESRD Patients

The 21st Century Cures Act has created new insurance options enabling end stage renal disease (ESRD) patients to switch from a traditional Medicare plan to Medicare Advantage (MA) with the choice to enroll starting in October.

In December 2016, President Obama signed the 21st Century Cures Act with a principal goal to promote discovery, development, and delivery of cures for serious illnesses. The act also addresses mental health delivery services and the opioid crisis.

Prior to the passage of this new law, patients with kidney failure were one of the only groups unable to enroll in Medicare Advantage (MA) with a few exceptions, such as patients who had already enrolled before their diagnosis or those who have successfully received a transplant. The 21st Century Cures Act lifts these restrictions.

“Patients with kidney failure generally live with multiple medical conditions and depend on many different medications for their treatment,” said Dr. Rob Kossmann, Executive Vice President and Chief Medical Officer for Fresenius Medical Care North America. “The opportunity now during Medicare Open Enrollment for these patients to choose Medicare Advantage, will help us deliver an even more patient-driven path to care coordination, helping us to meet the essential goal of improving health outcomes.”

As the enrollment period approaches, insurance companies are preparing for a shift in ESRD patient care and insurance management. Patients living with kidney failure currently have access to traditional Medicare, but this may not be the best choice for patients looking for more complete medical coverage in one plan. Providing patients with access to all their viable coverage options sets them up for success in whichever plan they choose.

The Centers for Medicare and Medicaid Services (CMS) has reportedly stated that they expect as many as 83,000 ESRD patients to eventually switch to Medicare Advantage. Patients may be driven to switch because of lower premiums, caps in out-of-pocket costs, or expanded benefits such as coverage for pharmaceuticals and other care.

Each plan, either original Medicare or MA, has distinctive characteristics for ESRD patients to consider. Traditional Medicare includes Medicare Part A (hospital insurance) and Part B (medical insurance), and members pay 20 percent of dialysis costs. As an alternative, Medicare Advantage acts as an “all in one" plan, which includes prescription coverage (Part D) and in some cases additional benefits such as vision, hearing, and dental, which traditional Medicare does not provide.

At Fresenius Health Partners, a leader in care coordination for patients with kidney failure, the changes are an opportunity to refine new models of care that are increasingly showing benefits.

“We see this as an opportunity to further expand and demonstrate the effectiveness of our coordinated-care models, which ultimately reduce overall spending and improve patient quality outcomes,” said David Pollack, president of Fresenius Health Partners.