Big news! Starting in 2021, Medicare beneficiaries with end-stage renal disease (ESRD) will be allowed to enroll in Medicare Advantage plans. This is a significant change that will have major impacts on both the healthcare choices of ESRD patients and Medicare Advantage spending.
The Cures Act Removes the ESRD Enrollment Barrier
A fact sheet from CMS says that the Cures Act allowed Medicare-eligible individuals with ESRD to enroll in Medicare Advantage plans starting on January 1, 2021. According to the fact sheet, “By implementing the changes of the Cures Act to remove the barrier that beneficiaries with ESRD now face in terms of enrolling in MA plans, we are empowering them to choose the type of Medicare coverage that best meets their needs.”
ESRD’s Potential Impact on Medicare Advantage Claims and Premiums
According to AHIP, before this rule change, Medicare beneficiaries with ESRD were sometimes covered by a Medicare Advantage plan. This could happen, for example, if they were diagnosed with ESRD after enrolling in the plan. Approximately 130,000 Medicare Advantage enrollees have ESRD, and it is estimated that 83,000 more beneficiaries with ESRD will enroll in Medicare Advantage plans through 2026.
This development could have a significant impact on Medicare claims and premiums. Although only 1 percent of Medicare current beneficiaries have ESRD, these beneficiaries account for 7 percent of all Medicare spending, according to AHIP.
AHIP contracted Wakely Consulting Group LLC to prepare a financial impact summary. According to Wakely, if every Medicare beneficiary with ESRD enrolled in Medicare Advantage, premiums would need to increase by $18 per member per month. Alternatively, supplemental benefits could be decreased to offset the costs.
How to Help Your Clients
Starting in 2021, ESRD patients who were previously barred from enrolling in Medicare Advantage will have the option of selecting a Medicare Advantage plan for their coverage needs.
For clients with ESRD, the opportunity to enroll in Medicare Advantage plans may come as a welcome relief. Start communicating with your clients and prospects now so they are ready to assess their options during the Medicare Advantage enrollment period.
CMS has not yet released many details about how this change will be implemented. We will keep you posted as more information is forthcoming.