Expansion and Marketing of Medicare Advantage to Persons With End-Stage Kidney Disease

PMCID: PMC12175025

PMID: 40526382

DOI: 10.1001/jamanetworkopen.2025.16359

Journal: JAMA network open

Publication Date: 2025-6-17

Authors: Brazier JF, Trivedi AN, Tyler DA, Shield RR, Gadbois EA

Key Points

• MA plans offer expanded coverage for ESKD patients, but marketing often obscures critical limitations in care
• Open enrollment marketing can overwhelm patients, leading to potentially suboptimal insurance choices
• Healthcare providers should carefully guide ESKD patients through insurance selection, emphasizing individualized needs over generalized marketing claims

Summary

This qualitative study explored perceptions of Medicare Advantage (MA) plan expansion for end-stage kidney disease (ESKD) patients among representatives from MA plans, kidney care management companies, and dialysis organizations. The research revealed significant challenges in MA marketing and insurance selection for this vulnerable patient population, highlighting a complex landscape of potential benefits and substantial limitations.

The study uncovered that while MA plans marketed expanded coverage as advantageous, many participants noted critical gaps in understanding ESKD patients' complex medical needs. Dialysis organizations and healthcare professionals expressed concerns about misleading marketing practices, limited benefits, and potential financial risks for patients. Key challenges included inadequate transportation benefits, network restrictions, and supplementary services that often failed to address the specific requirements of ESKD patients.