Racial and ethnic disparities in access to and enrollment in high‐quality Medicare Advantage plans

Park, Sungchul; Werner, Rachel M.; Coe, Norma B.

doi:10.1111/1475-6773.13977

Cited by 23 publications

(21 citation statements)

References 31 publications

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“…As payments to MA plans do not account for social risk factors, this may lead to systematic underpayments for socially marginalized enrollees creating an incentive to avoid enrolling socially marginalized enrollees. One way to achieve this is to avoid offering a plan in counties with a disproportionate share of socially marginalized groups 22 . Second, higher premiums in integrated MA plans may serve as barriers to enrollment.…”

Section: Discussionmentioning

confidence: 99%

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Differences between integrated and non‐integrated plans in Medicare Advantage

Park

Langellier

Meyers

2022

Health Services Research

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Objective: To understand differences in financial performance, quality performance, supplemental benefits provision, and enrollee composition between integrated and non-integrated plans in the Medicare Advantage (MA) program.Data Sources: We used data from the Center for Medicare and Medicaid Services for 2015-2017. We included 156 integrated MA plans (31 unique contracts) and 2096 non-integrated MA plans (392 unique contracts).Study Design: We estimated linear probably models for financial performance, quality performance, supplemental benefits provision, and enrollee composition with state fixed effects and contract random effects. We adjusted for county-level market structure-related factors, cost-related factors, and demand-related factors. Our primary independent variable was an indicator of plan-provider integration.

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Section: Discussionmentioning

confidence: 99%

“…One way to achieve this is to avoid offering a plan in counties with a disproportionate share of socially marginalized groups. 22 Second, higher premiums in integrated MA plans may serve as barriers to enrollment. Evidence suggests that MA enrollees were more sensitive to financial dimensions of health insurance such as premiums.…”

Section: Discussionmentioning

confidence: 99%

Differences between integrated and non‐integrated plans in Medicare Advantage

Park

Langellier

Meyers

2022

Health Services Research

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“…Park, Werner, and Coe show that while Black, Hispanic, Asian, and Pacific Islander enrollees tend to enroll in lower-quality star-rated plans relative to White enrollees; these enrollment differences are largely explained by differences in county-level MA plan offerings. 17 Fewer studies have compared disparities in quality between MA and TM. Moreover, within the small literature that has examined this question, the findings have been inconsistent.…”

Section: Introductionmentioning

confidence: 99%

“…Some of the observed racial and ethnic disparities in MA may be driven by differences in the quality of plans beneficiaries select. Park, Werner, and Coe show that while Black, Hispanic, Asian, and Pacific Islander enrollees tend to enroll in lower‐quality star‐rated plans relative to White enrollees; these enrollment differences are largely explained by differences in county‐level MA plan offerings 17 …”

Section: Introductionmentioning

confidence: 99%

Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage

Gangopadhyaya

Zuckerman

Rao

2023

Health Services Research

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Objective Test whether racial‐ethnic disparities in the access and use of care differ between Traditional Medicare (TM) and Medicare Advantage (MA). Data Source Secondary data from the 2015–2018 Medicare Current Beneficiary Survey (MCBS). Study Design Measure Black‐White and Hispanic‐White disparities in access to care and use of preventive services within TM, within MA, and assess the difference‐in‐disparities between the two programs with and without controls for factors that could influence enrollment, access, and use. Data Collection/Extraction Pool 2015–2018 MCBS data and restrict to non‐Hispanic Black, non‐Hispanic White, or Hispanic respondents. Principal Findings Black enrollees have worse access to care relative to White enrollees in TM and MA, particularly for cost‐related measures such as not having problems paying medical bills (11–13 pp. lower for Black enrollees; p < 0.05) and satisfaction with out‐of‐pocket costs (5–6 pp. lower; p < 0.05). We find no difference in Black‐White disparities between TM and MA. Hispanic enrollees have worse access to care relative to White enrollees in TM but similar access relative to White enrollees in MA. Hispanic‐White disparities in not delaying care due to cost and not reporting problems paying medical bills are narrower in MA relative to TM by about 4 pp (significant at the p < 0.05 level) each. We find no consistent evidence that Black‐White or Hispanic‐White differences in the use of preventive services differ between TM and MA. Conclusions Across the measures of access and use studied here, racial and ethnic disparities in MA are not substantially narrower than in TM for Black and Hispanic enrollees relative to White enrollees. For Black enrollees, this study suggests that system‐wide reforms are required to reduce existing disparities. For Hispanic enrollees, MA does narrow some disparities in access to care relative to White enrollees but, in part, because White enrollees do not do as well in MA as they do in TM.

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“…Evidence suggests that enrollment in high-rated MA plans was lower among racial and ethnic minority enrollees than White enrollees, partly due to fewer high-rated plans available in their counties of residence. 20 This indicates that several structural features in payment adjustment and star ratings could incentivize MA plans to discourage enrollment among racial and ethnic minority groups. Consequently, this may create and perpetuate structural racism in health and health care.…”

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confidence: 99%

Association of Medicare Advantage Star Ratings With Racial and Ethnic Disparities in Hospitalizations for Ambulatory Care Sensitive Conditions

2022

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Background: Enrollment in high-quality Medicare Advantage (MA) plans, measured by a 5-star quality rating system, was lower among racial and ethnic minority enrollees than White enrollees partly due to fewer high-quality plans available in their counties of residence. This may contribute to racial and ethnic disparities in ambulatory care sensitive condition (ACSC) hospitalizations.Objective: We examined whether there were racial and ethnic disparities in ACSC hospitalizations among MA enrollees overall and by star rating.Methods: Using the Medicare enrollment and claims data for 2016, we identified White, Black, Hispanic, and Asian/Pacific Islander enrollees in MA plans. We estimated racial and ethnic disparities in ACSC hospitalizations (per 10,000 enrollees) overall and by star rating.Results: We found that the adjusted rates of ACSC hospitalizations were significantly higher among Black enrollees than White enrollees overall [39.4 (95% confidence interval: 36.3-42.5)]. However, no significant disparities were found among Hispanic and Asian/Pacific Islander enrollees. The adjusted rates of ACSC hospitalizations were higher in lower-rated plans than higher-rated plans in all racial and ethnic groups. The significant disparities in ACSC hospitalizations by star rating were the most pronounced between White and Black enrollees. We found suggestive evidence that enrollment in lower-rated plans was associated with higher disparities in ACSC hospitalizations between White and Black enrollees.Conclusions: Substantial disparities in ACSC hospitalizations exist between White and Black enrollees in MA plans, especially for lower-rated plans. Policies aimed at reducing racial disparities in ACSC hospitalizations could include improving access to highrated plans.

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Racial and ethnic disparities in access to and enrollment in high‐quality Medicare Advantage plans

Cited by 23 publications

References 31 publications

Differences between integrated and non‐integrated plans in Medicare Advantage

Differences between integrated and non‐integrated plans in Medicare Advantage

Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage

Association of Medicare Advantage Star Ratings With Racial and Ethnic Disparities in Hospitalizations for Ambulatory Care Sensitive Conditions

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