Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2023 Mar 14;329(10):810-818.
doi: 10.1001/jama.2023.1426.

Medicare Advantage Enrollment Among Beneficiaries With End-Stage Renal Disease in the First Year of the 21st Century Cures Act

Kevin H Nguyen  1   2 , Eunhae G Oh  2 , David J Meyers  2 , Daeho Kim  2 , Rajnish Mehrotra  3 , Amal N Trivedi  2   4
Affiliations
Comment

Medicare Advantage Enrollment Among Beneficiaries With End-Stage Renal Disease in the First Year of the 21st Century Cures Act

Kevin H Nguyen et al. JAMA. .

Abstract

Importance: Before 2021, most Medicare beneficiaries with end-stage renal disease (ESRD) were unable to enroll in private Medicare Advantage (MA) plans. The 21st Century Cures Act permitted these beneficiaries to enroll in MA plans effective January 2021.

Objective: To examine changes in MA enrollment among Medicare beneficiaries with ESRD after enactment of the 21st Century Cures Act overall and by race or ethnicity and dual-eligible status.

Design, setting, and participants: This cross-sectional time-trend study used data from Medicare beneficiaries with ESRD (both kidney transplant recipients and those undergoing dialysis) between January 2019 and December 2021. Data were analyzed between June and October 2022.

Exposures: 21st Century Cures Act.

Main outcomes and measures: Primary outcomes were the proportion of Medicare beneficiaries with prevalent ESRD who switched from traditional Medicare to MA between 2020 and 2021 and those with incident ESRD who newly enrolled in MA in 2021. Individuals who stayed in traditional Medicare were enrolled in 2020 and 2021 and those who switched to MA were enrolled in traditional Medicare in 2020 and MA in 2021.

Results: Among 575 797 beneficiaries with ESRD in 2020 or 2021 (mean [SD] age, 64.7 [14.2] years, 42.2% female, 34.0% Black, and 7.7% Hispanic or Latino), the proportion of beneficiaries enrolled in MA increased from 24.8% (December 2020) to 37.4% (December 2021), a relative change of 50.8%. The largest relative increases in MA enrollment were among Black (72.8% relative increase), Hispanic (44.8%), and dual-eligible beneficiaries with ESRD (73.6%). Among 359 617 beneficiaries with TM and prevalent ESRD in 2020, 17.6% switched to MA in 2021. Compared with individuals who stayed in traditional Medicare, those who switched to MA had modestly more chronic conditions (6.3 vs 6.1; difference, 0.12 conditions [95% CI, 0.10-0.16]) and similar nondrug spending in 2020 (difference, $509 [95% CI, -$58 to $1075]) but were more likely to be Black (difference, 19.5 percentage points [95% CI, 19.1-19.9]) and have dual Medicare-Medicaid eligibility (difference, 20.8 percentage points [95% CI, 20.4-21.2]). Among beneficiaries who were newly eligible for Medicare ESRD benefits in 2021, 35.2% enrolled in MA.

Conclusions and relevance: Results suggest that increases in MA enrollment among Medicare beneficiaries with ESRD were substantial the first year after the 21st Century Cures Act, particularly among Black, Hispanic, and dual-eligible individuals. Policy makers and MA plans may need to assess network adequacy, disenrollment, and equity of care for beneficiaries who enrolled in MA.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Ms Oh reported receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; grant R01DK129388) during the conduct of the study and grants from the National Institute on Aging (T32AG023482-17) outside the submitted work. Dr Mehrotra reported receiving grants from NIDDK during the conduct of the study; serving on the Northwest Kidney Centers board of trustees; serving as editor in chief of the American Society of Nephrology; and receiving a stipend from CJASN outside the submitted work. Dr Trivedi reported receiving grants from NIDDK during the conduct of the study and grants from the National Institute of Minority Health and Health Disparities, National Institute on Aging, Department of Veterans Affairs, Agency for Healthcare Research and Quality, and Department of Defense outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Proportion of Medicare Beneficiaries With End-Stage Renal Disease (ESRD) Who Were Enrolled in Medicare Advantage in 2019-2021
A, The numerator is the monthly number of all Medicare beneficiaries with ESRD who were enrolled in a Medicare Advantage (MA) plan. The denominator is the monthly number of all Medicare beneficiaries with ESRD. See eTable 3 in the Supplement for monthly counts of Medicare beneficiaries with ESRD between January 2019 and December 2021. B, For estimates stratified by race and ethnicity, the numerator is the race and ethnicity–specific monthly number of all Medicare beneficiaries with ESRD who were enrolled in an MA plan and the denominator is the monthly number of all Medicare beneficiaries with ESRD from each racial and ethnic group. Race and ethnicity are from the Master Beneficiary Summary File, which uses an algorithm developed by the Research Triangle Institute to classify beneficiaries as Hispanic or Asian or Pacific Islander according to data from the Social Security Administration or whether they have a first or last name that the institute determined was likely Hispanic or Asian. C, For estimates stratified by dual Medicare-Medicaid coverage, the numerator is the monthly number of all Medicare beneficiaries with ESRD who were enrolled in an MA plan and who had dual Medicare-Medicaid coverage for at least 1 month in a calendar year, and the denominator is the monthly number of all Medicare beneficiaries with ESRD with dual Medicare-Medicaid coverage for at least 1 month in a calendar year.
See this image and copyright information in PMC

Comment on

References

    1. Patzer RE, McClellan WM. Influence of race, ethnicity and socioeconomic status on kidney disease. Nat Rev Nephrol. 2012;8(9):533-541. doi:10.1038/nrneph.2012.117 - DOI - PMC - PubMed
    1. Nguyen KH, Thorsness R, Swaminathan S, et al. . Despite national declines in kidney failure incidence, disparities widened between low- and high-poverty US counties. Health Aff (Millwood). 2021;40(12):1900-1908. doi:10.1377/hlthaff.2021.00458 - DOI - PMC - PubMed
    1. US Renal Data System. 2020 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2021. Accessed February 16, 2023. https://adr.usrds.org/2020
    1. 21st Century Cures Act, HR 34, 114th Cong (2015).
    1. Federal Register. Medicare and Medicaid programs: contract year 2021 and 2022 policy and technical changes to the Medicare Advantage program, Medicare Prescription Drug Benefit program, Medicaid program, Medicare Cost Plan program, and programs of all-inclusive care for the elderly. Proposed rule. February 18, 2020. Accessed February 16, 2023. https://www.federalregister.gov/documents/2020/02/18/2020-02085/medicare...

Publication types