How CMS payments to Medicare Advantage plans differ for ESRD beneficiaries versus other Medicare beneficiaries

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By Catherine M. Murphy-Barron, Eric Buzby | 13 September 2017

The Medicare Advantage (MA) benchmark for beneficiaries with end-stage renal disease (ERSD) is calculated using a less refined methodology than that used for other Medicare beneficiaries, and it is likely that the MA benchmark for an ERSD beneficiary in any one plan is not a true representation of the expected fee-for-service cost of providing Medicare services for that beneficiary. This paper examines the two methodologies and identifies inconsistencies.

This paper was sponsored by the Blue Cross Blue Shield Association.