ACCESS TO CARE AMONG PERSONS WITH END STAGE RENAL DISEASE AFTER ENROLLMENT IN MEDICARE ADVANTAGE - Research findings and qualitative interview themes

Sep 29, 2026

Prior to the 21st Century Cures Act, Medicare Advantage (MA) enrollment for people with end-stage renal disease (ESRD) was restricted. Since the policy change, MA enrollment for ESRD has risen markedly, yet effects on patients and involved organizations remained unclear. Using qualitative methods, 48 interviews with MA plans, dialysis organizations, and kidney care management companies identified themes on how MA enrollment alters access to dialysis, providers, transplant services, and supplementary benefits. Results indicate home dialysis use may increase while provider and transplant network limits can reduce options, including vision and dental coverage.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Abstract

Policy change context

Qualitative methods

Reported impacts on care access

Implications for patients and decision support

Innovation in Aging, 2025, Vol. 9, No. S2 1045 Abstract citation ID: igaf122.3522 ACCESS TO CARE AMONG PERSONS WITH END STAGE RENAL DISEASE AFTER ENROLLMENT IN MEDICARE ADVANTAGE Denise Tyler1, Emily Gadbois2, Joan Brazier3, and Amal Trivedi3, 1. Miami University, Hancock, Maine, United States, 2. Brown 1046 Innovation in Aging, 2025, Vol. 9, No. S2 University School of Public Health, Providence, Rhode Island, United States, 3. Brown University, Providence, Rhode Island, United States Prior to the 21st Century Cures Act, enrollment in Medicare Advantage (MA) by people with end-stage renal disease (ESRD) was only allowed in limited circumstances. Enrollment in MA by those with ESRD has grown by over 70 percent since the Cures Act, but little is known about the effects of this policy change on those with ESRD and the organizations involved, such as MA plans and dialysis providers. This study, part of a larger mixed methods study on this topic, used qualitative methods to explore access to health care and other services by those with ESRD after enrollment in MA. We conducted 48 interviews with representatives from MA plans, dialysis organizations, and kidney care management companies and qualitatively analyzed these to identify key themes. Participants reported that MA enrollment has impacted patient access to dialysis, health care providers, transplant services, and supplementary benefits. Participants reported that the use of home dialysis modalities had possibly increased, that patients sometimes neglected to consider reduced access to other providers, especially specialists, when selecting MA, and that network restrictions on transplant centers may be affecting patients’ ability to receive transplants. Finally, while some touted the benefits of vision and dental coverage for this population, others reported limited coverage and networks resulting in patients being unable to utilize these benefits. These results suggest that older adults with ESRD may need additional information and resources to ensure their insurance decisions don’t affect their access to needed health care, services, and preferred providers.

FAQs

What policy change enabled broader Medicare Advantage enrollment for people with ESRD?

The 21st Century Cures Act expanded MA enrollment eligibility for people with end-stage renal disease beyond limited prior circumstances.

How was the study conducted to examine access to care after MA enrollment?

The study used qualitative methods, conducting 48 interviews with representatives from MA plans, dialysis organizations, and kidney care management companies and then qualitatively analyzing responses for key themes.

What did participants report about how MA enrollment affected access to dialysis, providers, and transplants?

Participants reported impacts on access to dialysis, health care providers, and transplant services, including possible increases in home dialysis modalities and restrictions from networks—especially for transplant centers.

Sep 29, 2026

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