End-Stage Renal Disease (ESRD) represents one of Medicare’s most medically complex and financially costly populations yet historically has been underserved in both Medicare and Medicare Advantage (MA). Despite representing less than 1% of total beneficiaries, ESRD accounts for a disproportionately large share of Medicare expenditures. Traditional MA plans often lack the specialized networks, care coordination, and benefit designs required to address ESRD patients’ intensive needs. While ESRD Chronic Condition Special Needs Plans (C-SNPs) have begun to fill this gap, their adoption remains extremely limited nationwide.
In 2026, CMS is expanding the C-SNP condition category from ESRD to CKD (chronic kidney disease), allowing plans to serve beneficiaries across the full kidney disease continuum—from earlier-stage CKD to dialysis-dependent ESRD. This policy shift enables MA plans to intervene sooner, coordinate care more effectively, and help patients avoid or delay kidney failure, ultimately improving quality of life and reducing long-term costs. Integrating CKD and ESRD into a single SNP also aligns with CMS’s value-based care strategy and addresses significant equity gaps. This paper outlines the challenges ESRD patients face, the limitations of current MA benefits, the unique requirements of ESRD C-SNPs, and the potential impact of the upcoming CKD-ESRD SNP model.
