Medicare Advantage Sees Increasing Number of Black and Hispanic Enrollees

The number of Black, Hispanic, and dually enrolled Medicare Advantage (MA) beneficiaries increased at a faster rate than White and nondual beneficiaries between 2009 and 2018, according to a new study published in Health Affairs.

The study, published in June, gathered data on 82,626,490 people from the Medicare Master Beneficiary Summary File and reports by the Centers for Medicare and Medicaid Services. The number of beneficiaries who are Black, Hispanic, and dually enrolled increased from 23% to 38%, 33% to 48%, and 18% to 37%, respectively.

MA thus saw a 66% increase among Black beneficiaries, a 43% increase among Hispanic beneficiaries, and a 101% increase among those dually enrolled. By comparison, White beneficiaries increased by 46% and nondual enrollees by 43%.

Enrollment in special needs plans fluctuated throughout the study period. In 2018, however, 43% of Hispanic and 55% of dually enrolled beneficiaries enrolled in special needs plans in comparison to 10% of White beneficiaries.

White beneficiaries were overall “more broadly distributed” across different plans. Beneficiaries from racial and ethnic minority groups were more likely to select lower-quality plans, and Hispanic beneficiaries were more likely to select plans with lower premiums.

The study also compared enrollees by neighborhood Social Deprivation Index, an index of neighborhood-level deprivation, calculated from 9 variables in the American Community Survey and reported as a percentile for each ZIP code or county. People were more likely to enroll in MA if they lived in neighborhoods with higher quintiles of disadvantage, with those in the highest quintile of disadvantage contributing to the largest growth in MA enrollment over time.

“In the research and policy discourse, Medicare Advantage is often considered monolithic. Our findings suggest that a more nuanced interpretation is needed to understand the current program and its likely future state,” researchers noted.

MA comprised 35% of all Medicare beneficiaries in 2018, compared to 23% in 2009. The study notes that MA enrollment could include most of Medicare’s Black, Hispanic, and dually enrolled beneficiaries within five years if current trends continue. 

“There is a growing body of literature indicating that marginalized MA enrollees may face substantial disparities in outcomes. Thus, MA plans may need to become a key partner in finding effective ways to address those disparities,” researchers concluded. “Specifically, the fact that Black and Hispanic beneficiaries tended to be enrolled in lower-quality plans may need greater attention from policy makers.”

Reference:
Meyers DJ, Mor V, Rahman M, Trivedi AN. Growth in Medicare Advantage greatest among Black and Hispanic enrollees. Health Affairs. 2021;40(6):945-950. doi:10.1377/hlthaff.2021.00118