HELP REMOVE MEDICARE ADVANTAGE RESTRICTIONS FROM ESRD PATIENTS
FROM THE NKF
On July 7th, Congressmen Jason Smith (R-MO), John Lewis (D-GA), Gus Bilirakis (R-FL), Kurt Schrader (D-OR), and Tom Marino (R-PA) introduced the ESRD Choice Act (H.R. 5659). Starting in 2020, this bill will give individuals with kidney failure access to Medicare Advantage (MA) plans. It will also require education for individuals with end stage renal disease (ESRD) to aid them in making informed decisions about MA coverage. Support this important option for dialysis patients. See link: https://secure2.convio.net/…/Advocacy;jsessionid=7974C9E69B
Since the program was created in 2003, ESRD patients are the only group specifically denied the option to enroll in MA plans (currently Medicare beneficiaries who have Chronic Kidney Disease can enroll in MA and can remain in their MA plan after they progress to ESRD). Removing government restrictions that prevent ESRD patients from enrolling in MA plans will allow ESRD beneficiaries the same freedom of choice in coverage as other Medicare enrollees. Allowing ESRD patients to select these plans may help some patients minimize their out-of-pocket expenses and access additional benefits that some MA plans provide like transportation and dental.
The National Kidney Foundation (NKF) and ESRD patients need your help to ask Congress to expand Medicare options for kidney patients. Please personalize your emails to your elected officials to share your or your family’s story.
Thank you for contacting your Representative (to find your lawmaker, follow this link: http://donate.kidney.org/site/PageServer…)on behalf of kidney disease patients who deserve these protections.
Troy Zimmerman
Vice President for Government Relations
National Kidney Foundation

A few points about the ESRD Choice Act:

1. Medicare Advantage works with a closed network, so there are little or no co-payments or deductibles to be paid.

2. It provides patients with an alternative choice in insurance coverage that all seniors in the Medicare program have that most ESRD patients do not.

3.  It provides additional benefits to ESRD patients including transportation and dental.

4. Medical Advantage plans have out-of-pocket maximums that Medicare Fee-For-Service does not, so patients that can’t get Medigap plans in certain states either because the premiums are too high or they are not offered to ESRD patients may be subjected to medical bills that are well over $7k (because Medicare fee-for-service charges 20% coinsurance for all medical services including visits to practitioners and dialysis treatments). 

5.  In those states where the patient either has no Medicare Supplement or has missed a short deadline to apply for a Medicare Supplement (like my home state, Indiana), A Medicare Advantage plan would at least cover you for a kidney transplant in centers contained in the network.

6.  Under an MA plan, out-of-pocket expenses are capped and reducing the ESRD Patient's financial risk. 

7. This new MA bill has one major difference from the others; It removes organ procurement expenses from the Medicare Advantage benchmark (which in the most simple terms is used to determine how much CMS will pay MA plans to manage their patient populations).  Instead all organ procurement expenses (not living donor costs) will be handled by Medicare Part A  - similar to how Hospice works for MA beneficiaries.    One of the rationales for this change is that it makes the bill not score.  

One pager from the NKF:

ESRD Choice Act (H.R 5659)
For more information, contact Troy Zimmerman at TroyZ@kidney.org.
Issue: Since Medicare Advantage (MA) was created in 2003, end stage renal disease (ESRD) patients are the only group specifically denied the option to enroll in these plans (except under rare circumstances). This denies ESRD patients the same rights and access to comprehensive health care options extended to other Medicare beneficiaries.
H.R. 5659, the ESRD Choice Act, would remove government restrictions that prevent ESRD patients from enrolling in MA plans and provide kidney patients the same freedom of choice in coverage as other Medicare beneficiaries. Medicare Advantage plans may help ESRD patients reduce out-of-pocket expenses and provide access to additional benefits like transportation and dental. This bill will also require education for individuals with ESRD to aid them in making informed decisions about MA coverage.
Background:
Medicare Advantage plans are offered by private insurance companies and have varying monthly premiums and coverage benefits. They are required to provide all Medicare Part A and Medicare Part B benefits and can offer additional coverage such as prescription drug, dental, vision, and hearing.
Due to government regulations, ESRD patients are nearly always denied entry into MA. Exceptions include if the patient is already in an MA plan when they develop ESRD, if their current health insurance organization offers an MA plan, if the patient had a transplant and still qualifies for Medicare, or the individual can join a Medicare Special Needs Plan if one is available in his or her area.
Request: Cosponsor and help pass the ESRD Choice Act (H.R. 5659, introduced by Congressmen Jason Smith (R-MO), John Lewis (D-GA), Gus Bilirakis (R-FL), Kurt Schrader (D-OR), and Tom Marino (R-PA)) to help provide ESRD patients with choices and access to comprehensive health insurance coverage through Medicare Advantage plans.