Dialysis Patient Citizens (DPC) hailed the introduction of H.R. 5659 as the latest in a series of milestones toward opening Medicare Advantage (MA) enrollment to end-stage renal disease (ESRD) patients. With bi-partisan introduction by Reps. Jason Smith (R-MO), John Lewis (D-GA), Gus Bilirakis (R-FL), Kurt Schrader (D-OR) and Tom Marino (R-PA), this legislation is a momentous step forward to providing dialysis patients increased access to insurance.

“As a dialysis patient of 5 years, I am fortunate to have secondary insurance to cover what Medicare does not, however I know many patients in my facility don’t have that luxury. Providing dialysis patients access to Medicare Advantage will greatly help to reduce our out of pocket costs while improving our overall health with care coordination measures,” said Stephen Anderson, a patient advocate from Indianapolis, Indiana working to secure more insurance options for dialysis patients.

The Medicare Payment Advisory Commission (MedPAC) endorsed opening what was then called Medicare + Choice to dialysis patients 15 years ago, but nothing came of the recommendation for over a decade. Several recent developments have given new momentum to this policy proposal:

  • The Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 1130/S. 538), which included a provision opening MA to ESRD patients, gained 66 House co-sponsors and 10 Senate co-sponsors
  • The Senate Finance Committee’s Chronic Care Working Group Report included opening MA to ESRD patients as policy option.
  • In comments on the Senate Finance discussion draft, opening MA to ESRD patients was endorsed by the most prominent beneficiary advocacy groups, as well as by the two largest insurance industry trade associations.
  • An empirical study comparing outcomes of dialysis patients grandfathered into Medicare Advantage plans found that they have lower mortality rates than their peers in FFS.

“The exponential growth in support for increasing dialysis patient choice, shows that opening up Medicare Advantage to ESRD patients is an idea whose time has come,” said Hrant Jamgochian, Chief Executive Officer of Dialysis Patient Citizens. “Patients should be able to choose the insurance plan that works best for them, including Medicare Advantage if they want to access care coordination programs and out-of-pocket limits that are not available in traditional Medicare.”