How Industry Stakeholders View Medicare Advantage Expansion for Patients with Kidney Disease

July 7, 2025

A qualitative study explores how MA plan leaders, kidney care managers, and dialysis providers perceive the benefits, risks, and marketing practices surrounding MA enrollment for patients with end-stage kidney disease.

By this year, enrollment in Medicare Advantage (MA) plans, which feature private managed care insurers to receive payments from the governments to provided services covered by Medicare, is estimated to reach 35.4 million beneficiaries. This represents more than half of the total Medicare market.

Among MA plans, many of them offer their enrollees the opportunity for lower cost-sharing liability, along with benefits that may not necessarily be covered by traditional Medicare (TM), including dental, vision, and hearing care; enrolling in MA is also linked to decreases in costs of care, lower out-of-pocket spending, and a boost in quality outcomes.2

Challenges in Medicare Advantage: Prior authorization and network limitations

On the other hand, MA plans can sometimes have restricted provider networks, and can either demand prior authorization for certain services, or deny patients of certain healthcare treatments. Knowing this, traversing this insurance marketplace can prove to be a challenge for both older and chronically ill adults.

Before the 21st Century Cures Act (often known as the Cures Act), people with end-stage kidney disease (ESKD) had fewer insurance options and could only access TM, MA plans if enrolled prior to diagnosis, or a Special Needs Plan designed specifically for those with kidney failure.

Key Takeaways

The 21st Century Cures Act expanded Medicare Advantage eligibility to individuals with end-stage kidney disease (ESKD), increasing coverage options but also raising concerns about access and adequacy of care.
Industry leaders expressed concerns about aggressive MA marketing practices and noted that limited provider networks and prior authorization requirements often fail to meet the complex needs of ESKD patients.
The study underscores the need for better patient education, stronger broker engagement, and policy interventions to ensure MA plans deliver equitable, high-quality care for people with ESKD.

Study explores stakeholder perspectives on MA expansion

This all changed with the expansion of the Cures Act on Jan. 1, 2021. It allowed individuals with ESKD to enroll in MA, due to expansion that boosted insurance coverage options for those with kidney failure. In light of this update, a qualitative study published in JAMA Network Open explored how representatives from MA plans, kidney care management companies, and dialysis organizations view the expansion and marketing of MA products for individuals with ESKD.1

Methodology and participant overview

Participants were recruited using snowball sampling—a technique that involves current participants helping to recruit future participants—while outreach was based on Centers for Medicare & Medicaid Services (CMS) data. Everyone who participated had self-identified as knowledgeable about the topic. Researchers also designed and tested various interview guides that were tailor-made to each participant group, in order to safeguard that was consistency to the questioning. Interviews lasted anywhere from 30 minutes to an hour, and were conducted between Jan. 21, 2022 and May 1, 2024 by either phone or Zoom. They were recorded with permission, and participants were given a $50 gift card for participating.

The researchers then utilized a modified grounded theory and content analysis approach to examine the transcripts. The interviewees consisted of executives from eight MA plans, clinical leadership representing five kidney care management companies, and leadership positions and staff members from six dialysis organizations.

Overall, a total of 48 interviews with 56 participants representing MA plans, kidney care management companies, and dialysis organizations were conducted. Upon further analysis, the study authors found three themes:

Organizations used a multitude of outreach strategies to inform patients with kidney failure about new insurance options, and highlighted the importance of patient choice.
Although MA plans provide possible benefits, expanded broker partnerships were still needed in order to support decision-making.
Mass marketing of MA was extensive but misleading at times. Providers raised concerns about limited coverage and insufficient support for the needs of ESKD patients.

Call to action: Policy and research implications

The investigators expressed their concerns with this study, noting that “in this qualitative study of clinical, administrative, and healthcare leaders in kidney care, findings showed that for persons with ESKD, researching and selecting insurance coverage that best suits their complex medical needs, financial constraints, and healthcare provider networks was challenging. This study also highlighted potentially misleading marketing tactics targeting this medically vulnerable population and the engagement of brokers and/or agencies by DOs to provide resources to patients navigating the insurance marketplace.

“Further research is needed to better understand the long-term impacts of MA on health outcomes for persons with ESKD and the effects of limited networks, preauthorization processes, and inadequacy of supplemental benefits for dialysis and transplantation services. Policymakers should consider the significant role marketing plays in insurance selection decisions and take steps to curtail aggressive and misleading marketing tactics.”

References

1. Brazier JF, Trivedi AN, Tyler DA, Shield RR, Gadbois EA. Expansion and Marketing of Medicare Advantage to Persons With End-Stage Kidney Disease. JAMA Netw Open. 2025;8(6):e2516359. doi:10.1001/jamanetworkopen.2025.16359

2. Saraceno N. Does Risk-Based Payment Drive Better Care in Medicare Advantage? Pharmaceutical Commerce. June 26, 2025. Accessed July 7, 2025. https://www.pharmaceuticalcommerce.com/view/does-risk-based-payment-drive-better-care--medicare-advantage-