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Medicare Advantage: What Is Changing For Beneficiaries With End-Stage Renal Disease (ESRD) In 2021?

posted by AHIP

on March 12, 2020

What Are the Rules on MA for Individuals with ESRD?

ESRD, or kidney failure, affects more than 500,000 Medicare beneficiaries. These individuals are not currently eligible to enroll in the MA program but may be covered by an MA plan if they developed ESRD after enrollment or were grandfathered through employer-sponsored coverage. Currently, 130,000 people with ESRD, or 25% of this population on Medicare, have coverage through an MA plan.

MA enrollment by individuals with ESRD is expected to accelerate beginning in 2021, when a provision of the 21st Century Cures Act (Cures Act) lifts the current enrollment restrictions. CMS estimates that an additional 83,000 people with ESRD will enroll in MA by 2026, which represents an increase of 63%.

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