ESRD Patients Can Now Enroll in Medicare Advantage Plans

Jae Oh, CFP, author of Maximize Your Medicare, details how ESRD patients can enroll in Medicare Advantage plans starting in 2021
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End state renal disease (ESRD) patients can now enroll in Medicare Advantage plans, according to Jae Oh, CFP, author of Maximize Your Medicare.

And that's good news for the more than 500,000 Medicare beneficiaries with ESRD, or kidney failure, who will have "unrestricted rights" to enroll in a Medicare Advantage plan. "It's going to be a great relief to many people who face the very, very high costs of dialysis," said Oh.

According to America's Health Insurance Plans (AHIP), these individuals are not currently eligible to enroll in the Medicare Advantage program but may be covered by a Medicare Advantage plan if they developed ESRD after enrollment or were grandfathered through employer-sponsored coverage. Currently, 130,000 people with ESRD, or 25% of this population on Medicare, have coverage through a Medicare Advantage plan, according to AHIP.

One possible wrinkle: "This change could affect not only ESRD patients, but also may change the deductibles/copays/out of pocket maximums for the entire Medicare Advantage population," said Oh.

Oh's advice: Be very careful with respect to networks. According to Medicare.gov, many Medicare Advantage plans (like HMOs or PPOs) have networks of health care providers which include doctors, other health care providers, hospitals, and facilities. In some plans, you may be able to go out-of-network for certain services, usually for a higher cost

According to Oh, the way that Medicare Advantage plans work is that the cost-sharing -- your copays, or co-insurance -- vary from plan to plan based on where you receive your dialysis treatment. "And because of that, it's going to be very interesting in 2021, to see how the Medicare Advantage plans handle it, and then how the dialysis patients enroll in those plans," he said.

During Medicare's open enrollment period (October 15 - December 7), Medicare beneficiaries should use Medicare.gov's plan finder to find a plan that's right for them.

Oh's advice: "Look through the specific details of the plans available in your area in order to understand first the cost. And then further investigation will have to go into the provider, the center of the dialysis treatment. You'll want to check on both of those criteria in order to find which plan is best for you."

And don't just think that the plan that you have today is the one that's best for you next year. Medicare Advantage plans are subject to change every year. As a result, Oh said it's in the consumer's best financial and health care interests to check these details. "The market is so competitive," he said. "The benefits are changing every year. It just is a smart consumer choice to check."

Upcoming Webinar

Medicare ABCs

When: October 5, 2020 - Time: 1 PM ET

Limited free access to Retirement Daily subscribers!

Jae Oh, author of Maximize Your Medicare and Retirement Daily contributor, will discuss:

- Medicare Eligibility and Enrollment

- Parts A, B, D

- Medicare Advantage

- Medigap

- NEW Changes for 2021

There will be ample time for questions during and after the presentation.

Attendance is limited. Register now!