Major Medicare plans are few and far between in disadvantaged areas

Looking for a Medicare Advantage plan with a five-star quality rating? You’re less likely to find one available to you if you live in a county with higher poverty and unemployment, a new study published in JAMA Network Open finds.

These geographic disparities may be contributing to unequal health outcomes and limiting federal funds from reaching the neediest regions, according to the researchers.

“What this means is that Medicare beneficiaries who live in the most socially disadvantaged counties have fewer opportunities to choose highly rated Medicare Advantage plans that can provide high-quality care,” said Avni Gupta, a health policy researcher who recently earned her doctorate in health. policy and management from the NYU School of Global Public Health and is now at the Commonwealth Fund.

More than half of all Medicare beneficiaries — nearly 31 million people — enroll in Medicare Advantage plans, rather than opting for traditional Medicare. Medicare Advantage plans, also known as “Part C,” are offered by private health insurance companies that contract with Medicare and typically bundle inpatient, outpatient, and prescription drug coverage.

To help consumers compare the quality of Medicare Advantage programs, the Centers for Medicare & Medicaid Services (CMS) uses a five-star rating system, calculating scores based on nearly 40 indicators.

“Star ratings are intended to capture the performance of Medicare Advantage plans in past years, with better ratings demonstrating better quality care in areas such as chronic care management, screenings, vaccinations and other preventive services, appointments timeliness, care coordination, customer service and appeals handling,” said Gupta, lead author of the study.

Additionally, star ratings determine the bonus and rebate payments insurance companies receive from CMS; larger payouts for higher-rated plans may translate into better additional benefits for beneficiaries.

With enrollment in Medical Advantage plans increasing each year—and in particular, low-income black and Hispanic adults enrolling at higher rates in recent years—Gupta and her colleagues sought to understand whether quality assessments vary based on where you live.

Using Medicare Advantage 2023 star ratings — ranging from the highest ratings (4.5 or 5 stars) to the lowest ratings (less than 3.5 stars) — the researchers mapped plan availability in 3,075 counties. USA. They also looked at county-level characteristics using the Centers for Disease Control and Prevention’s Social Vulnerability Index, a calculation of 16 social determinants of health, including poverty, unemployment, education, disability, race and ethnicity, ability of English, housing and access. to transport.

They found that Medicare Advantage plans in the most disadvantaged counties were less likely to be highly rated (4.5 stars or higher) and more likely to have low ratings (3.5 stars or less).

“Our findings imply that beneficiaries who could benefit most from additional benefits may be able to choose only from plans that are least likely to have the financial resources to provide these benefits, given that lower star ratings translate into lower premiums and deductibles for insurance plans,” Gupta added. “Such a pattern of star ratings and social vulnerability could exacerbate disparities in health care access, experience, and outcomes.”

The researchers note that Medicare policies that calculate area-level vulnerability in the star rating system or incentivize plans serving such areas could help promote equity.

In addition to Gupta, study authors include José Pagán and Diana Silver of the NYU School of Public Health, Sherry Glied of the NYU Robert F. Wagner Graduate School of Public Service, and David Meyers of the Brown University School of Public Health.