Kidney Week

Abstract: FR-PO1029

Likelihood of Switching from Medicare Fee-for-Service Coverage to Medicare Advantage among Patients on Maintenance Dialysis in 2022

Session Information

• Social, Environmental, and Economic Determinants of Kidney Health
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Liu, Jiannong, Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

Jiannong Liu, PhD

• Guo, Haifeng, Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

Haifeng Guo, MS

• Wetmore, James B., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

James B. Wetmore, MD, MS

• Roetker, Nicholas S., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

Nicholas S. Roetker, MS, PhD

• Gilbertson, David T., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

David T. Gilbertson, PhD

• Johansen, Kirsten L., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

Kirsten L. Johansen, MD, FASN

Background

Medicare beneficiaries with end-stage kidney disease (ESKD) were able to switch from traditional Medicare fee-for-service (MFFS) to Medicare Advantage (MA) during open enrollment periods for the first time in 2021. About 11.6% of MFFS dialysis patients switched to MA in 2021, and switching was more common among patients who were younger, Black or Hispanic, poor or low-income, and living in the South. This study assesses whether patterns in switching were similar in 2022.

Methods

Using the United States Renal Data System data, we examined who switched to MA in January 2022 among adult (age ≥18 years) dialysis patients covered by MFFS as primary payor as of December 2021.

Results

In total, 240,360 patients were included; 6.5% switched from MFFS to MA in 2022. Switching was most common in individuals who were aged 55-64 years (9.0%), Black race (9.4%), Medicare-Medicaid dual enrolled (8.0%), in Medicare Part D (6.8%), or living in the South (8.4%) and least common among those who were aged 85+ (2.6%), Asian (3.7%), non-dually enrolled (5.4%), not in Medicare Part D (5.5%), or living in the Northwest (4.7%) (Table). The adjusted odds ratios for switching and the corresponding 95% confidence intervals are shown in the Table.

Conclusion

A smaller percentage of MFFS patients switched to MA in 2022 than in 2021, although switchers shared similar characteristics in both years. The availability of zero-premium plans and lower out-of-pocket spending limits will continue to incentivize switching to MA. However, whether the pre-authorization requirement and limited provider network will affect the quality of care or the rate of switching back to MFFS needs to be monitored.

Funding

• NIDDK Support