Medicare Advantage Growth in Dialysis Patients Raises Care and Policy Challenges

Medicare Advantage (MA) enrollment among patients receiving dialysis has significantly increased following regulatory changes introduced by the 21st Century Cures Act, which removed prior enrollment restrictions. This shift marks MA as the primary payer for dialysis patients, a development with notable implications for insurers, healthcare providers, and policymakers focused on dialysis care management and Medicare program design. MA plans provide benefits including out-of-pocket spending caps and additional services beyond what fee-for-service (FFS) Medicare offers, with some plans enhancing care coordination potentially improving patient outcomes. However, challenges persist related to limited provider networks, barriers due to prior authorizations, and uneven access to medications and transplant options for dialysis patients under MA. The growing dominance of MA complicates the application of value-based care models which traditionally rely on quality measures and payment frameworks designed for FFS Medicare patients receiving dialysis. Evaluating the comparative effectiveness of MA versus FFS Medicare is further hindered by selection bias and limited availability of comprehensive data. Researchers advise that to protect patient outcomes amid rising MA enrollment, stakeholders should prioritize improvements in data quality and transparency. Enhanced regulatory oversight and alignment of financial incentives across different patient populations are also critical to ensuring dialysis patients maintain access to high-quality, coordinated care. This peer-reviewed research underscores the evolving landscape of Medicare payment structures for dialysis and calls for policy adjustments to address the complexities introduced by the expansion of Medicare Advantage within this vulnerable patient group. Insights from this study provide guidance for insurers, providers, and regulators aiming to optimize Medicare dialysis care delivery and policy frameworks.