Beginning in 2021, people with End-Stage Renal Disease (ESRD) can enroll in Medicare Advantage Plans. Medicare Advantage Plans must cover the same services as Original Medicare but may have different costs and restrictions. However, Medicare Advantage Plans cannot set cost-sharing for either outpatient dialysis or immunosuppressant drugs higher than would be the beneficiary responsibility under Original Medicare.
If you have ESRD and are interested in enrolling in a Medicare Advantage Plan, it is important to consider provider networks and costs as you evaluate plans.
Each type of Medicare Advantage Plan has different network rules. A network is a group of doctors, hospitals, and medical facilities that work with a plan to provide services. Your costs are typically lowest when you use in-network providers and facilities.
Before enrolling in a Medicare Advantage Plan, make sure your providers, including your dialysis facility, are in network. Ask your current providers which plans they accept. While some plans offer coverage outside their network, costs and restrictions are often higher.
When you are comparing Medicare Advantage Plans, find out how much you will owe for services you need, such as dialysis and immunosuppressants.
Medicare Advantage Plans have annual maximum out-of-pocket limits on your Part A and Part B care ($7,550 in 2022). These limits can help protect you if you have high health care costs. When you are comparing Medicare Advantage Plans, it may be helpful to calculate if you are likely to reach the maximum out-of-pocket limit during the year. This is because after you reach the limit, you do not pay anything for in-network covered inpatient or outpatient services for the rest of the year.
Learn more about other factors to consider before you join a Medicare Advantage Plan.
If you are deciding between Original Medicare and Medicare Advantage, use this chart to get started.