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

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

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: Racial and ethnic minority enrollees in Medicare Advantage (MA) plans tend to be in lower-quality plans, measured by a 5-star quality rating system. We examine whether differential access to high-rated plans was associated with this differential enrollment in high-rated plans by race and ethnicity among MA enrollees. Data Sources: The Medicare Master Beneficiary Summary File and MA Landscape File for 2016. Study Design: We first examined county-level MA plan offerings by race and ethnicity. We then examined the association of racial and ethnic differences in enrollment by star rating by controlling for the following different sets of covariates: (1) individual-level characteristics only, and (2) individual-level characteristics and county-level MA plan offerings. Data Collection/Extraction Methods: Not applicable. Principal Findings: Racial and ethnic minority enrollees had, on average, more MA plans available in their counties of residence compared to White enrollees (16.1, 20.8, 20.2, vs. 15.1 for Black, Asian/Pacific Islander, Hispanic, and White enrollees), but had fewer number of high-rated plans (4-star plans or higher) and/or more number of low-rated plans (3.5-star plans or lower). While racial and ethnic minority enrollees had lower enrollment in 4–4.5 star plans than White enrollees, this difference substantially decreased after accounting for county-level MA plan offerings (−9.1 to −0.5 percentage points for Black enrollees, −15.9 to −5.0 percentage points for Asian/Pacific Islander enrollees, and −12.7 to 0.6 percentage points for Hispanic enrollees). Results for Black enrollees were notable as the racial difference reversed when we limited the analysis to those who live in counties that offer a 5-star plan. After accounting for county-level MA plan offerings, Black enrollees had 3.2 percentage points higher enrollment in 5-star plans than White enrollees. Conclusions: Differences in enrollment in high-rated MA plans by race and ethnicity may be explained by limited access and not by individual characteristics or enrollment decisions.

Original languageEnglish
Pages (from-to)303-313
Number of pages11
JournalHealth Services Research
Volume58
Issue number2
DOIs
StatePublished - Apr 2023

Bibliographical note

Funding Information:
This work was supported by the National Institute of Aging, the National Institutes of Health (R01AG057501; P30AG012836). This work was supported by the Ewha Womans University Research Grant of 2022.

Funding Information:
Funding informationThis work was supported by the National Institute of Aging, the National Institutes of Health (R01AG057501; P30AG012836).

Publisher Copyright:
© 2022 Health Research and Educational Trust.

Keywords

  • Medicare Advantage
  • access to care
  • health disparity
  • high-quality plan
  • race
  • traditional Medicare

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