Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence Rhode Island.
JAMA Netw Open. 2024 Sep 3;7(9):e2432772. doi: 10.1001/jamanetworkopen.2024.32772.
In January 2021, under the 21st Century Cures Act, Medicare beneficiaries with end-stage renal disease (ESRD) were permitted to enroll in private Medicare Advantage (MA) plans for the first time. In the first year of the Cures Act, there was a 51% increase in MA enrollment among beneficiaries with ESRD.
To examine changes in MA enrollment among Medicare beneficiaries with ESRD in the first 2 years of the Cures Act and, among beneficiaries newly enrolled in MA in 2021, to assess the proportion of beneficiaries who switched MA contracts and how the characteristics of contracts changed.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, population-based time-trend study was conducted from January 2020 to December 2022. Eligible participants included Medicare beneficiaries with ESRD. Data analysis was conducted from August 2023 to March 2024.
Enrollment in Medicare during the first 2 years of the 21st Century Cures Act.
The primary outcomes were enrollment in MA, switching between traditional Medicare (TM) and MA, and switching between MA contracts from 2021 to 2022.
There were 718 252 unique Medicare beneficiaries with ESRD between 2020 and 2022 (1 659 652 beneficiary-years). In 2022, there were 583 203 beneficiaries with ESRD (mean [SD] age, 64.9 [14.1] years, 245 153 female (42.0%); 197 988 Black [34.0%]; 47 912 Hispanic [8.2%]). The proportion of beneficiaries with ESRD who were enrolled in MA increased from 25.1% (118 601 of 472 234 beneficiaries) in January 2020 to 43.1% (211 896 of 491 611 beneficiaries) in December 2022. Increases in MA enrollment were larger in the first year of the Cures Act (12.6 percentage points [pp]; 95% CI 12.3-12.8 pp) compared with the second year (5.7 pp; 95% CI, 5.5-5.9 pp). Changes between December 2020 and December 2022 ranged between 49.3% for Asian or Pacific Islander beneficiaries (difference = 13.0 pp; 95% CI, 12.2-13.8 pp) and 207.2% for American Indian or Alaska Native beneficiaries (difference = 17.0 pp; 95% CI, 15.3-18.7 pp). Changes were high among partial dual-eligible (difference = 35.5 pp; 95% CI, 34.9-36.1 pp; 134.7% increase) and fully dual-eligible beneficiaries (difference = 22.8 pp, 95% CI, 22.5-23.1 pp; 98.0% increase). Among 53 366 beneficiaries enrolled in MA in 2021, 37 439 (70.2%) remained in their contract, 11 730 (22.0%) switched contracts, and 4197 (7.9%) switched to TM in 2022. Compared with the characteristics of MA enrollees with ESRD in 2021, those in 2022 were more likely to be in contracts with lower premiums and with a rating of 4.5 stars or higher.
In this cross-sectional time-trend study of Medicare beneficiaries with ESRD, MA enrollment continued to increase in the second year of the Cures Act, particularly among racially or ethnically minoritized individuals and dual eligible populations. These findings suggest need to monitor the equity of care for beneficiaries with ESRD as they enroll in managed care plans.
2021 年 1 月，根据《21 世纪治愈法案》，终末期肾病 (ESRD) 的医疗保险受益人首次被允许参加私人医疗保险优势 (MA) 计划。在该法案实施的第一年，ESRD 受益人的 MA 参保人数增加了 51%。
在《21 世纪治愈法案》实施的头两年，研究 ESRD 医疗保险受益人的 MA 参保人数变化情况，以及在 2021 年新参加 MA 的受益人中，评估有多少受益人的 MA 合同发生变更，以及合同的特征发生了怎样的变化。
设计、地点和参与者：这是一项基于人群的横断面时间趋势研究，从 2020 年 1 月至 2022 年 12 月进行。合格的参与者包括 ESRD 的医疗保险受益人。数据分析于 2023 年 8 月至 2024 年 3 月进行。
在《21 世纪治愈法案》实施的头两年期间，医疗保险的参保情况。
主要结局是 MA 的参保情况、从传统医疗保险（TM）到 MA 的转换情况，以及 2021 年至 2022 年期间 MA 合同的转换情况。
在 2020 年至 2022 年期间，共有 718252 名独特的 ESRD 医疗保险受益人（1659652 个受益年份）。2022 年，有 583203 名 ESRD 受益人（平均[标准差]年龄 64.9[14.1]岁，女性 245153 人[42.0%]；黑人 197988 人[34.0%]；西班牙裔 47912 人[8.2%]）。ESRD 受益人的 MA 参保比例从 2020 年 1 月的 25.1%（472234 名受益人中的 118601 人）增加到 2022 年 12 月的 43.1%（491611 名受益人中的 211896 人）。在《21 世纪治愈法案》实施的第一年，MA 参保人数增加了 12.6 个百分点（95%CI 12.3-12.8 个百分点），而第二年增加了 5.7 个百分点（95%CI，5.5-5.9 个百分点）。2020 年 12 月至 2022 年 12 月期间的变化范围从亚裔或太平洋岛民受益人的 49.3%（差异=13.0 个百分点；95%CI，12.2-13.8 个百分点）到美国印第安人或阿拉斯加原住民受益人的 207.2%（差异=17.0 个百分点；95%CI，15.3-18.7 个百分点）。部分双重资格（差异=35.5 个百分点；95%CI，34.9-36.1 个百分点；134.7%的增加）和完全双重资格（差异=22.8 个百分点；95%CI，22.5-23.1 个百分点；98.0%的增加）受益人的变化幅度较大。在 2021 年参加 MA 的 53366 名受益人中，37439 人（70.2%）留在了原合同中，11730 人（22.0%）更换了合同，4197 人（7.9%）在 2022 年转为 TM。与 2021 年 ESRD 医疗保险参保者的 MA 合同特征相比，2022 年的参保者更有可能签订保费较低、评级为 4.5 星或更高的合同。
在这项针对 ESRD 医疗保险受益人的横断面时间趋势研究中，在《21 世纪治愈法案》实施的第二年，MA 的参保人数继续增加，尤其是在种族或族裔少数群体和双重合格人群中。这些发现表明，需要监测 ESRD 受益人的管理式医疗计划参保情况的公平性。
