Expanded Access to Medicare Advantage for Individuals with End-Stage Renal Disease in 2021

In addition to individuals age 65 and older and people with disabilities, Medicare covers people with End-Stage Renal Disease (ESRD), also known as kidney failure.

ESRD, also known as stage 5 of CKD, occurs when an individual’s kidneys permanently stop functioning. Unless they can receive a kidney transplant, people with ESRD undergo dialysis, typically several times a week. In 2019, over 520,000 people were treated for ESRD through renal dialysis, with an additional 220,000 who received a kidney transplant.

Currently, most beneficiaries with ESRD receive coverage through Traditional FFS Medicare. Some can enroll in Medicare Advantage under limited circumstances and beneficiaries who develop ESRD while enrolled in a Medicare Advantage plan can retain their coverage.

As required by Congressional action, starting in 2021, all ESRD beneficiaries will have the option to enroll in Medicare Advantage, even after diagnosis. Medicare Advantage is well-suited to provide ESRD beneficiaries with coverage due to its annual out-of-pocket limit for consumers, supplemental benefits, and ability to coordinate care.