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When Medicare HMO plans came into being in the 1970s, members of the renal community were concerned that insurance companies operating them might put other interests ahead of the needs of the members they were established to serve. Nothing changed when these plans were renamed Medicare + Choice in 1997 and Medicare Advantage (MA) in 2003.1
Are MA plans workable today for those on dialysis? Here are some questions to consider:
- How are MA plans paid? Medicare pays more to insurance companies that administer MA plans than what it costs traditional Medicare to treat people. This creates a burden to taxpayers—with no improvement in care quality.2
- Does the MA plan follow CMS rules described in the Medicare Managed Care Manual?3
- With an average of three or more chronic health conditions, people with CKD need access to specialists. Do MA plan primary physicians offer timely referral to nephrologists and other specialists for people with CKD?