Need a kidney transplant? Avoid Medicare Advantage

Although Medicare Advantage plans are now paid to cover care for people with end-state kidney disease, a new study published in JAMA reveals that people needing kidney transplants were far less likely to get them than people in traditional Medicare. These findings fit neatly with other research comparing care for people with costly conditions in Medicare Advantage and traditional Medicare. Bottom line: Once you need costly care, you’re gambling with your health and sometimes your life in Medicare Advantage.

The researchers looked at results for 630,848 people with Medicare and found that people in Medicare Advantage with kidney disease needing kidney transplants had lower kidney transplant rates than people in traditional Medicare, 2.51 v 4.60 per thousand.

The researchers also found that a lower portion of Medicare Advantage enrollees were on transplant waitlists than traditional Medicare enrollees, 3.05 v. 4.64 per 1000 person-months. Moreover, of those on waitlists, Medicare Advantage enrollees had lower transplant rates, 16.59 v. 20.85 per 1000 person-months.

The researchers believe that more oversight of Medicare Advantage plans “might be needed” to ensure that people in these corporate insurer-administered plans get the treatments they need. That said, it’s not at all clear that oversight will make any difference so long as the financial incentive for the insurers is to keep people from getting kidney transplants. Insurers maximize profits when they spend less on care.

To be clear, people with kidney failure who do not get a kidney transplant are much more likely to die and experience a poor quality of life than people who get a kidney transplant. Dialysis is not as beneficial to them.

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