5 Important Questions About Medicare Advantage for People on Dialysis

Finding an insurance plan that best covers your treatments, medications, and other needs can be challenging when you’re on dialysis. There are many choices to explore, each with pros and cons. In 2021, a new option became available for people with end stage renal disease (ESRD)—Medicare Advantage, also called Medicare Part C or MA plans. Learning the basics of Medicare Advantage is the first step in deciding if it’s right for you.

5 Questions to Help You Decide if Medicare Advantage Is the Right Insurance Plan for You

As with any insurance plan, you may have questions about Medicare Advantage’s requirements, enrollment periods, benefits, costs, and more. Getting answers to these questions will help you determine if it’s your right insurance option.

1. What is Medicare Advantage?

Medicare Advantage plans are Medicare-approved health insurance plans offered through private insurance companies that combine the benefits of Original Medicare programs (also called Parts). For example, Medicare Advantage combines Medicare Parts A and B into one plan, for a user-friendly insurance option with broader coverage than Original Medicare. Coverage may include medical treatments (including dialysis), prescriptions, routine dental, vision, and hearing.

Because Medicare Advantage plans are offered through private insurance companies, you have access to the same types of plans an employer might offer, including health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

2. How is Medicare Advantage different from Original Medicare?

Original Medicare plans cover different areas of healthcare:

Part A covers inpatient hospital care, hospice, some nursing home care, and home healthcare.
Part B covers all outpatient care, including dialysis services, doctor visits, and certain medications, including some for dialysis or kidney transplants.
Part D helps with prescription costs not covered by Part B.

For the most complete coverage available under Original Medicare, you must sign up for Parts A, B, and D.

By comparison, Medicare Advantage can offer all-in-one plans with all the benefits of Parts A, B, and D—plus more. Medicare Advantage plans are often easier to manage—you have coverage benefits in 1 plan instead of several, and the convenience of only 1 insurance card. Other ways Medicare Advantage differs from Original Medicare include:

Annual out-of-pocket expenses are capped, lowering overall costs. Note: It’s important to make sure you understand out-of-pocket costs on the plan you choose.
Plans are managed by private health insurance companies approved by Medicare.
Additional benefits are available, may include routine dental, vision, and hearing.
Medications for dialysis or post-kidney transplant are often covered, however, it’s important to make sure your medications are included in the plan you choose.
Plans use networks, like employer group health plans, so it’s important to make sure your nephrologist and other doctors are in-network.
Affordable monthly plan premiums.

3. Who qualifies for Medicare Advantage?

You are eligible for Medicare Advantage if you meet all the following qualifications:

You have Medicare Part A and Part B.
You’re a US citizen or lawfully present in the US.
You live in the service area of the plan you want to join.

If you have ESRD and are trying to decide on Medicare coverage, as of January 2021 you can select either Original Medicare or a Medicare Advantage plan.

Medicare Advantage plans differ by region. You’ll want to understand the plans available in your area and make sure your doctors, hospital, transplant center, and medications are in-network and covered under the plan you choose.

4. How do I enroll in a Medicare Advantage plan?

There are many ways to join Medicare Advantage plans, including:

Call Medicare at 1-800-MEDICARE or visit Medicare.gov
Visit the State Health Insurance Assistance Program at SHIPHelp.org
Talk to an independent licensed insurance agent—like one from SelectQuote. SelectQuote can help you understand your insurance options and compare health insurance plans available to you. To contact SelectQuote, call 1-855-259-8449 (TTY: 1-877-486-2048) or visit SelectQuote.com/FreseniusKidneyCare.

There are many options and costs to consider when deciding which health plan is best for your needs. Before you make any change to your insurance coverage, talk to an insurance coordinator. They can help you understand your current coverage—and your available insurance options—before you make a decision.

5. Can my Medicare Advantage plan be canceled or dropped?

Medicare Advantage cannot drop you because of a medical condition, such as ESRD. If you meet the requirements and stay up to date on payments, you remain eligible and your coverage continues. Usually, your Medicare Advantage plan is automatically renewed each year.

Sometimes plans change or become unavailable based on where you live. Changes to your ESRD treatment (such as a kidney transplant) may also affect coverage. If you have questions or concerns, contact your Fresenius Kidney Care insurance coordinator.

Get Advice before Changing Insurance Coverage

Health insurance can be difficult to navigate, especially if you have specific ESRD and dialysis care needs. When considering Medicare Advantage, be aware of eligibility, costs, benefits, and enrollment requirements. Be sure your physicians, treatment centers, and medications are included in the plan you select.

Remember, you have people and places to turn to when you need information or assistance. Fresenius Kidney Care provides articles and other resources—such as our Medicare 101 Guide—that can help you understand all your Medicare options, including Medicare Advantage. The guide includes details about Medicare plans and add-ons, kidney transplant coverage considerations, and tips for choosing a plan.

Another valuable resource is our team of insurance coordinators, who can help you understand your health insurance options so you can choose the plan that best fits your medical and financial needs. If you have questions about insurance or you’re getting ready to change your coverage, and are an existing FKC dialysis patient, take the time to speak with one of our insurance coordinators first. If you are an existing FKC dialysis patient, just fill out our Insurance Options form, and we will put you in touch with a member of our team.

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