Fewer patients who underwent [dialysis](https://www.mcknights.com/marketplace/marketplace-experts/changing-the-paradigm-of-dialysis-in-nursing-homes/) from 2012 to 2017 signed up for Medicare and instead opted for private insurance, a new study finds.
The study covered 2,005 people with end-stage kidney disease who were between 18 and 64. Just over 70% were between 45 and 64 years old. The people weren’t enrolled in Medicare when they started dialysis, according to the Dec. 6 [report](https://jamanetwork.com/journals/jama-health-forum/fullarticle/2827155) in _JAMA Health Forum_.
The rate of switching from private insurance to Medicare one year after dialysis initiation declined from 68.1% in 2012-2013 to 52.2% and 45.8% in 2014-2015 and 2016-2017, respectively. In the years after the Affordable Care Act (ACA) launched, a lower number of participants with the disease who were starting dialysis signed up for Medicare. That compares with more people signing up for Medicare two years before the ACA launched, the data showed.
Meanwhile, the rate of switching from Medicaid to Medicare one year after beginning dialysis went from 68.9% in 2012-2013 to 58.3% in 2014-2015 and then to 54.6% in 2016-2017.
Throughout the entire study period (2012 to 2017), quarterly dialysis spending in the first year of dialysis among patients with private insurance was $26,351-$29,781. That compares to $10,039-$12,741 in those with Medicare.
Medicare enrollment may have slowed because people were offered new private insurance options as a result of the 2014 ACA and introduction of the ACA Marketplace. Authors of the report said their findings raise concerns about the effectiveness of Medicare.