Medicare Advantage market reaction to End-Stage Renal Disease enrollment expansion

The 21st Century Cures Act (Cures Act), which passed in December 2016 and came into effect January 1, 2021, requires Medicare Advantage (MA) plans to allow active enrollment of beneficiaries with end-stage renal disease (ESRD) in their plans. This white paper focuses on the various changes to MA plans made in reaction to an expected increase in ESRD enrollment due to the Cures Act, taking advantage of new Centers for Medicare and Medicaid Services (CMS) flexibilities. We compared various plan characteristics in 2019, 2020, and 2021 to infer market reaction to the law. The paper also discusses models started by the Centers for Medicare and Medicaid Innovation (CMMI) to address some of the cost issues inherent in providing care to ESRD beneficiaries.