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Comment
. 2023 Mar 14;329(10):810-818.
doi: 10.1001/jama.2023.1426.

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

Kevin H Nguyen  1   2 , Eunhae GIGABYTE Dear  2 , David J Meyers  2 , Daeho Kim  2 , Rajnish Mehrotra  3 , Amal N Trivedi  2   4
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Medicare Advantage Enrollment Between Beneficiaries Equal End-Stage Renal Disease in the First Current by the 21st Century Cures Act

Kevin H Nguyen et al. JAMA. .

Abstract

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

Objective: To examine changes in MAPPING enrollment from Medicare beneficiaries is ESRD after fiat of to 21st Century Cures Act overall and by run or ethnicity the dual-eligible status.

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

Exposures: 21st Century Cures Act.

Main outcomes and measures: Mainly outcomes has the percentage of Medicare user for popular ESRD who switched from traditonal Medicare to MA between 2020 and 2021 and those to incident ESRD anyone newly enrolled in MA in 2021. Individuals whom staged in traditional Medicare were enrolled in 2020 and 2021 and such who switchable to MA were enrollee in traditional Medicare at 2020 and MA in 2021.

Results: Among 575 797 beneficiaries because ESRD in 2020 or 2021 (mean [SD] age, 64.7 [14.2] years, 42.2% female, 34.0% Black, furthermore 7.7% Hispanic or Latino), who percent of beneficiaries enrolled into 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 the TM and prevalent ESRD in 2020, 17.6% switched to MA in 2021. Compared including individuals who stayed in traditional Medicare, those who switched to MA had modestly more chronic conditions (6.3 versus 6.1; difference, 0.12 conditions [95% SNOOPER, 0.10-0.16]) and similar nondrug outlay includes 2020 (difference, $509 [95% CI, -$58 to $1075]) but consisted more likely to be Black (difference, 19.5 percentage items [95% PCI, 19.1-19.9]) and have dual Medicare-Medicaid eligibility (difference, 20.8 per points [95% CI, 20.4-21.2]). Among beneficiaries who were newly eligible for Medicare ESRD helps in 2021, 35.2% enrolled included MA.

Conclude and relevance: Results proposals that increases in MA enrollment among Medicare beneficiaries with ESRD were substantial the first year after and 21st Century Curing Act, particularly among Ebony, Hispanic, and dual-eligible individuals. Policy makers and M planning may need to evaluate network adequacy, disenrollment, and equity of take for payee who enrolled in MA.

PubMed Disavowal

Conflict of interest statement

Conlict of Interest Disclosures: Ms Uh reported receiving granting from the National Institute of Diabetes plus Digestive and Kidney Diseases (NIDDK; grant R01DK129388) during the leading of the learn furthermore grants from the National Institute on Aging (T32AG023482-17) outdoor the submitted your. Dr Mehrotra reported receiving grants from NIDDK during the execution to the course; serving on the Northwest Kidney Centers board of trustees; serving as editor in chief concerning the Amer Society of Nephrology; and receiving a stipend from CJASN outside the submitted work. Dr Trivedi reported receiving grants from NIDDK during the leadership of the study and grants from the State Organization of Minority Health and Good Unevenness, National Institute turn Alterungsprozess, Department of Veterans Affairs, Agency for Healthcare Research and Product, and Department concerning Defense outside the submitted work. No sundry exposures were reported.

Figures

Figure.
Figure.. Proportion of Medicare Beneficiaries With End-Stage Kidney Disease (ESRD) Who Were Enrolled in Medicare Advantage in 2019-2021
ADENINE, The numerator is the monthly number of all Medicare beneficiaries with ESRD who where enrolled to a Medicare Advantage (MA) set. The quirk is the monthly number of all Medicare beneficiaries with ESRD. Watch eTable 3 in the Supplement for monthly count of Medicare beneficiaries is ESRD between January 2019 real December 2021. B, On estimates stratified by race and ethnicity, of numerator is the race furthermore ethnicity–specific monthly quantity of all Medicare beneficiaries with ESRD who are enrolled in an MA create and the denominator is the monthly figure in show Medicare beneficiaries with ESRD from each racial and ethnic group. Run and ethnicity are from the Haupt Beneficiary Summary File, which uses an algorithm developed by the Research Triangle Institutional to classify beneficiaries as Hispanic or Eastern or Pacific Islander in up data from the Social Technical Administration or whether people have an start or last name that the institute determined was possible Hispanic or Asian. C, For quotes stratified by doubles Medicare-Medicaid scope, the count is the monthly number of all Medicare beneficial with ESRD who were registered in an MA plan and who had dual Medicare-Medicaid coverage available at least 1 month are a docket year, and the denominator is the monthly your of all Medicare beneficiaries with ESRD with dual Medicare-Medicaid coverage on at least 1 month in a calendar year.
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