What is Medicare Advantage and Why is it the Most Important Contemporary Policy Affecting Kidney Disease?

Medicare Advantage (MA) enrollment among patients receiving dialysis has surged following the passage of the 21st Century Cures Act, which lifted prior restrictions on enrollment. As MA becomes the plurality payer for dialysis, understanding its implications for patients, providers, and policymakers is critical. MA offers out-of-pocket spending caps and additional services not covered under fee-for-service (FFS) Medicare. Some plans also prioritize care coordination, which may improve patient outcomes. However, concerns remain regarding limited provider networks, prior authorization barriers, and disparities in access to medications and transplants. The increasing shift to MA also challenges value-based care models, as most quality measures and payment models for patients receiving dialysis are limited to FFS Medicare. Although research examining the benefits and downsides of MA is paramount, a comparison of MA versus FFS Medicare is complicated by selection bias and incomplete or inaccessible data. To ensure that increasing enrollment into MA has not harmed patients, policymakers must enhance data fidelity and transparency, strengthen regulatory oversight, and align financial incentives across populations to safeguard access to high-quality care for patients receiving dialysis.