Although 80% of US patients who receive dialysis for end-stage kidney disease (ESKD) have Medicare as their primary payer, recent evidence suggests an increasing share with other coverage. Some policy makers allege that dialysis facilities encourage individual market enrollment by subsidizing individual market premiums through contributions to patient assistance foundations. This strategy could increase profits for facilities because commercial plans pay more for dialysis than Medicare, but could also increase individual market spending if patients receiving dialysis have above-average spending.
To our knowledge, little is known about the prevalence and spending of patients with ESKD in the individual market. Prior commercial market studies were limited to financial records of 1 chain, combined employer and individual plans, and only examined dialysis spending. To address these gaps, we used claims data for individual market plans and analyzed dialysis and nondialysis spending.