Federal policy changes to Medicare Advantage (MA) plans could disproportionately affect beneficiaries who identify as Black, are lower income, or lack a college degree, according to a new study.
New York University School of Global Public Health researchers, who examined Medicare trends from 2018 to 2020, found that compared to their white and higher-income counterparts, ethnic and racial minorities and patients who reported lower incomes were more likely to enroll in MA plans, which are offered by private insurers that contract with Medicare, for supplementary benefits like dental, vision, and hearing coverage.
Federal officials should therefore take those enrollment differences into consideration as they implement MA policy changes, like plan payment cuts, equity linked payments, and increased benefit flexibility, the researchers contended.
“Any benefit redesigns by MA plans could drive changes in enrollment patterns,” they wrote in a report published in JAMA on January 12. “The [Centers for Medicare and Medicaid Services (CMS)] is implementing major reforms to improve care and equity in MA, such as the health equity index, MA payment cuts, and increased flexibility in supplemental benefit offerings. Information about benefit preferences of beneficiaries may inform CMS regulation of benefits and enable MA plans to better meet the needs of underserved beneficiaries.”
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Specifically, researchers found that Black MA enrollees were nine percentage points more likely than white beneficiaries to sign up for plans with dental benefits, three percentage points more likely to enroll in eye benefits, and six percentage points more likely to enroll in eyewear benefits.
Lower-income enrollees—or those who earned less than 200% of the federal poverty level (about $25,500 for a single-person household in 2020)—were four percentage points more likely than higher-income beneficiaries to sign up for plans with comprehensive dental benefits.
Patients without a college degree, meanwhile, were nearly five percentage points more likely than those with higher education degrees to enroll in plans with comprehensive dental benefits, the study found.
Nearly all MA plans offer supplemental vision and hearing benefits—which are not offered as part of traditional Medicare—according to a January 2023 Government Accountability Office report.
In April 2023, Health and Human Services Department officials finalized a new rule that sought to strengthen the MA program and promote health equity. The rule, among many things, called for creating a health equity index in the star ratings program, which ranks MA plans based on quality metrics—and offers bonus payments to high achievers—for the 2027 star ratings.