Comparison of Ambulatory Care Access and Quality for Beneficiaries With Disabilities Covered by Medicare Advantage vs Traditional Medicare Insurance

Abstract

IMPORTANCEMedicare beneficiaries with disabilities aged 18 to 64 years face barriers accessing ambulatory care. Past studies comparing Medicare Advantage (MA) with traditional Medicare (TM) have not assessed how well these programs meet the needs of beneficiaries with disabilities. OBJECTIVE To compare differences in enrollment rates, ambulatory care access, and ambulatory care quality for beneficiaries with disabilities in MA vs TM. DESIGN, SETTING, AND PARTICIPANTS This cohort study included a nationally representative, weighted sample of 7201 person-years for beneficiaries aged 18 to 64 years with disability entitlement in the Medicare Current Beneficiary Survey from 2015 through 2018. Differences in program enrollment and in measures of access and quality by program enrollment were compared after adjusting for demographic, insurance, social, health, and area characteristics and after reweighting the sample by propensity to enroll in MA as estimated by observed confounders. Data analyses were conducted between November 1, 2020, and November 11, 2021. EXPOSURES Medicare Advantage vs TM program enrollment. MAIN OUTCOMES AND MEASURES Six patient-reported measures of ambulatory care access(usual source of care, primary care usual source of care, specialist visit) and quality (cholesterol screening, influenza vaccination, colon cancer screening). RESULTSThe mean (SD) age of the overall study population was 52.1 (11.0) years; 49.5% were female and 50.5% were male; 1.6% were Asian/Pacific Islander; 17.4%, Black; 10.2% Hispanic; 1.4%, Native American; 65.1%, White, and 4.2%, multiracial. Among all beneficiaries living in the community, individuals with disability entitlement were less likely to enroll in MA than other beneficiaries (34.8% vs 41.2%). The final sample of beneficiaries with disabilities included 2444 person-years in MA and 4757 person-years in TM. Beneficiaries with disabilities in MA vs TM were more likely to be of a minority race or ethnicity (35.7% vs 27.6%) and less likely to be enrolled in private insurance (11.9% vs 25.0%). Comparing MA with TM among beneficiaries with disabilities, those in MA had significantly better rates of access to a usual source of care (90.2% vs 84.9%;

Validation of a Population-Based Data Source to Examine National Cancer Clinical Trial Participation

“…Recent data suggest that Medicare Advantage enrollees do not differ significantly from Medicare FFS enrollees in terms of their age, race, income, and chronic conditions . However, Medicare Advantage patients are more likely to be in metropolitan areas and less likely to be in long-term care facilities . To date, there is currently no requirement for commercial insurance claims to include NCT identifiers; therefore, we do not know the extent to which clinical trial participation among patients with cancer and with commercial insurance can be identified.…”

“…Furthermore, this database captures Medicare beneficiaries in the FFS program alone, and the extent to which it is generalizable to older adults with commercial insurance is uncertain. Recent data suggest that Medicare Advantage enrollees do not differ significantly from Medicare FFS enrollees in terms of their age, race, income, and chronic conditions . However, Medicare Advantage patients are more likely to be in metropolitan areas and less likely to be in long-term care facilities .…”

Comparison of Medicare Advantage vs Traditional Medicare for Health Care Access, Affordability, and Use of Preventive Services Among Adults With Low Income

“…Although our study is among the first, to our knowledge, to focus on beneficiaries with low income, our findings have some similarities with prior studies of the entire cohort of Medicare beneficiaries. In 1 analysis of 2018 Medicare data, a similar proportion of beneficiaries with TM (5%) and MA (7%) reported problems obtaining needed health care, with approximately one-third in both groups reporting high costs as a barrier . This study also found that MA beneficiaries were slightly more likely to have a usual source of care, similar to our analysis, and receive more robust care management services.…”

“…Third, although the proportions of adults with MA vs TM who were dually enrolled in Medicare and Medicaid were identical in our study cohort, we did not include this variable in our models given that reports of dual enrollment may be undercaptured in the NHIS . Fourth, prior studies have shown that separating special needs plans from other MA plans can help improve comparisons of TM vs MA, and we were unable to do so with the available data . Fifth, our study used survey data, which may be subject to response bias .…”

Evaluation of Trends in Oncology Drug Spending in Medicare, 2016 to 2020

“…We adjusted Part B data using Medicare enrollment percentages to account for missing Medicare Advantage beneficiaries, whose utilization patterns and cancer prevalence are consistent with those of traditional Medicare beneficiaries (eMethods 2 and eTable 1 in the Supplement). Using the total number of oncology drugs in Parts B and D as the denominator, we calculated the share of drugs, claims, and spending across each program (eMethods 3 and eTable 2 in the Supplement).…”