This educational guide is based on the linked primary sources. It is not a Court publication, is not affiliated with the Court, and is not legal advice.
In brief
Overview
The case concerns the Marietta Memorial Hospital Employee Health Benefit Plan (the “Marietta Plan”) and DaVita Inc. over whether the plan differentiates benefits for patients with end‑stage renal disease (ESRD) in violation of the Medicare Secondary Payer Act.
The Supreme Court held that the Marietta Plan does not differentiate the benefits it provides to ESRD patients versus other enrollees.
Justice Kagan filed a dissent arguing that Congress did not intend to allow the plan’s approach and that the statute should be fixed.
Background and question before the Court
What each side argues
Petitioners
Petitioners argue that the Medicare Secondary Payer Act requires a group health plan to pay its benefits first for a 30‑month coordination period and not to consider Medicare eligibility or differentiate benefits based on an ESRD diagnosis.
Respondents
Respondents argue that differential treatment of outpatient renal dialysis is permissible because Congress recognized the unique, lifelong need of ESRD patients for dialysis.
What happened at oral argument
Justice Breyer asked, “Why does this not violate the statute from your point of view?”
According to Justice Alito, justice Alito expressed bafflement at the statutory language.
Justice Alito later asked, “Is that vulnerable? Is that illegal in your view?”
Justice Breyer asked, “Who are you going to compare it with?”
Justice Sotomayor asked, “Are you finished with—”
What the Court decided
The Court concluded that the Marietta Plan does not differentiate the benefits it provides to ESRD patients versus other enrollees.
Justice Kagan dissented, stating that Congress did not intend to permit the plan’s approach and that the statute must be corrected.
Why it matters
If relief were granted, dialysis participants could see out‑of‑pocket costs rise dramatically, from roughly $96 per treatment to as much as $1,800 per treatment.
The decision could increase overall Medicare spending and potentially reduce coverage options for ESRD patients.
Terms to know
No glossary terms are available for this guide.
Primary sources
Read the source materials on the official site or open the immutable repository copy used for this guide.
- 20c77ec9bddada9996a3-r1-f7fd77b06ae5ea33.pdforal argument transcript
- 45858f68e3f3ba312d47-r1-27a67cc0da8009ca.pdfopinion
Guide generated September 28, 2026. Automated validation accepted this version.