Medicare Advantage Enrollment Among Beneficiaries With End-Stage Renal Disease in the First Year of the 21st Century Cures Act
Medicare Advantage Enrollment Among Beneficiaries With End-Stage Renal Disease in the First Year of the 21st Century Cures Act
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DOI：
10.1001/jama.2023.1426
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发表时间：
2023-03-14
影响因子：
120.7
通讯作者：
Trivedi, Amal N.
中科院分区：
文献类型：
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作者：
Nguyen, Kevin H.;Oh, Eunhae G.;Trivedi, Amal N.
在2021年之前，大多数患有终末期肾病（ESRD）的Medicare受益人无法参加私人Medicare Advantage（MA）计划。《21世纪世纪治愈法案》允许这些受益人参加MA计划，自2021年1月起生效。目的研究《21世纪世纪治愈法案》颁布后，ESRD医疗保险受益人MA登记的变化，并按种族或民族和双重资格状态进行分析。这项横断面时间趋势研究使用了来自ESRD医疗保险受益人的数据（包括肾移植受者及接受透析者）。数据分析时间为2022年6月至10月。主要结果和指标主要结果是2020年至2021年期间从传统医疗保险转为MA的ESRD患者的医疗保险受益人比例，以及2021年新入组MA的ESRD患者比例。2020年和2021年继续参加传统医疗保险的人，2020年参加传统医疗保险的人和2021年参加MA的人。（平均[SD]年龄，64.7 [14.2]岁，女性42.2%，黑人34.0%，西班牙裔或拉丁裔7.7%），参加MA的受益人比例从24.8%（2020年12月）增加到37.4%（2021年12月），相对变化为50.8%。MA入学率的最大相对增长是黑人（相对增长72.8%），西班牙裔（44.8%）和ESRD的双重资格受益人（73.6%）。在2020年患有TM和ESRD的359617名受益人中，17.6%在2021年转为MA。与那些留在传统医疗保险的人相比，那些转向MA的人有更多的慢性疾病（6.3对6.1;差异，0.12条件[95% CI，0.10-0.16]）和2020年类似的非药物支出（差异，509美元[95% CI，-58美元至1075美元]），但更可能是黑人（差异，19.5个百分点[95% CI，19.1-19.9]），并具有双重Medicare-Medicaid资格（差异，20.8个百分点[95% CI，20.4-21.2]）。在2021年新获得医疗保险ESRD福利资格的受益人中，35.2%的人参加了MA。结论和相关性结果表明，在21世纪世纪治愈法案颁布后的第一年，ESRD医疗保险受益人中MA入学率大幅增加，特别是黑人，西班牙裔和双重资格的个人。政策制定者和MA计划可能需要评估网络的充分性，注销，以及参加MA的受益人的护理公平性。
IMPORTANCE Before 2021, most Medicare beneficiaries with end-stage renal disease (ESRD) were unable to enroll in private Medicare Advantage (MA) plans. The 21st Century Cures Act permitted these beneficiaries to enroll in MA plans effective January 2021.OBJECTIVE To examine changes in MA enrollment among Medicare beneficiaries with ESRD after enactment of the 21st Century Cures Act overall and by race or ethnicity and dual-eligible status.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional time-trend study used data from Medicare beneficiaries with ESRD (both kidney transplant recipients and those undergoing dialysis) between January 2019 and December 2021. Data were analyzed between June and October 2022. Exposures21st Century Cures Act.MAIN OUTCOMES AND MEASURES Primary outcomes were the proportion of Medicare beneficiaries with prevalent ESRD who switched from traditional Medicare to MA between 2020 and 2021 and those with incident ESRD who newly enrolled in MA in 2021. Individuals who stayed in traditional Medicare were enrolled in 2020 and 2021 and those who switched to MA were enrolled in traditional Medicare in 2020 and MA in 2021.RESULTS Among 575797 beneficiaries with ESRD in 2020 or 2021 (mean [SD] age, 64.7 [14.2] years, 42.2% female, 34.0% Black, and 7.7% Hispanic or Latino), the proportion of beneficiaries enrolled in MA increased from 24.8% (December 2020) to 37.4% (December 2021), a relative change of 50.8%. The largest relative increases in MA enrollment were among Black (72.8% relative increase), Hispanic (44.8%), and dual-eligible beneficiaries with ESRD (73.6%). Among 359617 beneficiaries with TM and prevalent ESRD in 2020, 17.6% switched to MA in 2021. Compared with individuals who stayed in traditional Medicare, those who switched to MA had modestly more chronic conditions (6.3 vs 6.1; difference, 0.12 conditions [95% CI, 0.10-0.16]) and similar nondrug spending in 2020 (difference, $509 [95% CI, -$58 to $1075]) but were more likely to be Black (difference, 19.5 percentage points [95% CI, 19.1-19.9]) and have dual Medicare-Medicaid eligibility (difference, 20.8 percentage points [95% CI, 20.4-21.2]). Among beneficiaries who were newly eligible for Medicare ESRD benefits in 2021, 35.2% enrolled in MA.CONCLUSIONS AND RELEVANCE Results suggest that increases in MA enrollment among Medicare beneficiaries with ESRD were substantial the first year after the 21st Century Cures Act, particularly among Black, Hispanic, and dual-eligible individuals. Policy makers and MA plans may need to assess network adequacy, disenrollment, and equity of care for beneficiaries who enrolled in MA.