Expansion and Marketing of Medicare Advantage to Persons With End-Stage Kidney Disease.

Importance: The 21st Century Cures Act expanded Medicare Advantage (MA) to include persons with kidney failure. Little is known about the impact of increased MA marketing for persons with end-stage kidney disease (ESKD). Objective: To examine varied perspectives on the expansion of MA to include persons with ESKD and associated marketing strategies. Design, Setting, and Participants: This qualitative study of interviews conducted from January 21, 2022, to May 1, 2024, used a modified grounded theory and content analysis approach to analyze transcripts. Interviewees included executives from 8 MA plans, clinical leadership of 5 kidney care management companies, and leadership and staff of 6 dialysis organizations that varied in size (enrollment) from all US Census regions. Exposure: One-time, semistructured interviews. Interview questions focused on the perceived effects of the expansion of MA to include persons with kidney failure. Main Outcomes and Measures: Thematic description of participant perspectives on the expansion of MA and associated marketing practices. Results: A total of 48 interviews with 56 executives and staff from MA plans, kidney care management companies, and dialysis organizations were completed. Analysis found 3 major themes. First, organizations used various outreach approaches to inform persons with kidney failure of their expanded insurance options. Participants recognized that personal choice without undue influence is paramount when older or chronically ill adults are selecting their insurance coverage. Second, MA has potential benefits for persons with ESKD, and organizations expanded partnerships with brokers and/or agencies to provide additional insurance-related resources. Third, the mass marketing approach used to advertise MA was ubiquitous and often reported as deceptive for older or chronically ill adults. Kidney health care professionals noted that constraints on eligibility, restricted health care networks, and limited benefits and services were frequently inadequate for the complex social and medical needs of their patient population. Conclusions and Relevance: In this qualitative study, findings show that MA marketing to increase enrollment is pervasive and intensifies during open enrollment. Policymakers and industry experts should consider the complexity of insurance selection decisions and monitor accuracy of MA marketing of ESKD-specific benefits.