Study Finds Disparities in Medicare Advantage

The quality of care Medicare Advantage participants receive varies based on their race, gender, and ethnicity according to a new report from the Centers for Medicare & Medicaid Services’ Office of Minority Health.

The report, based on data from Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and the Healthcare Effectiveness Data and Information Set (HEDIS), presents the following findings:

• Some disparities exist between patient experiences; most groups—except for Asian American and Native Hawaiian or other Pacific Islander (AA and NHPI) MA enrollees—showed disparities in 1 or 2 of 7 total measures. Scores for AA and NHPI MA enrollees were lower on most patient experience measures (5 of 7), but the interpretation of this finding is complicated because Asian American respondents are known to use response scales for CAHPS items differently from how other racial and ethnic groups use them (Mayer et al., 2016). There was variation across racial and ethnic groups on which patient experience measures were below the national average. Two or more race or ethnicity groups were below the national average on three measures—Getting Appointments and Care Quickly, Getting Needed Prescription Drugs, and Annual Flu Vaccine—which suggests possible barriers in access to care.
• Disparities on clinical care measures were more widespread. Scores for American Indian/Alaska Native (AI/AN), Black, and Hispanic MA enrollees were below the national average on large proportions of the clinical care measures that were investigated, such as measures in the diabetes care, behavioral health care, and overuse and appropriate use of medications domains. In contrast, scores for AA and NHPI MA enrollees were above the national average on a large proportion of the clinical care measures, and scores for White MA enrollees were almost always similar to the national average.
• Disparities were most common for AI/AN MA enrollees and Black MA enrollees, and those disparities spanned across multiple areas of clinical care. For AI/AN enrollees, scores on measures in the diabetes care domain were notably below average. For Black MA enrollees, scores on measures in the areas of behavioral health, cardiovascular care, diabetes care, and care coordination were notably below average.
• Clinical care results for AA and NHPI MA enrollees and Hispanic MA enrollees were mixed. Scores for AA and NHPI enrollees were above the national average on 13 of 41 measures (compared with below the national average on 5 of 41). Scores for Hispanic MA enrollees were above the national average on 12 of 41 measures (compared with below the national average on 11 of 41). For AA and NHPI MA enrollees scores on measures related to alcohol and other drug (AOD) dependence treatment were notably below average. For Hispanic MA enrollees scores on measures of AOD Dependence Treatment and Engagement in Cardiac Rehabilitation measures were notably below average.
• Scores for male and female MA enrollees on patient experience and clinical care measures were generally similar. However, male Multiracial enrollees had lower than average patient experience scores more often (4 of 7) than did female Multiracial enrollees (1 of 7).
• Patterns of disparities were similar to those in the 2023 Disparities in Health Care in Medicare Advantage by Race, Ethnicity, and Sex report. One exception was that in the previous year’s report female Multiracial enrollees had lower than average patient experience measures more often (3 of 7) than male Multiracial enrollees (1 of 7).

Learn more about the Office of Minority Health’s findings, find the data underlying these key points, and the implications for health equity from the report “Disparities in Health Care in Medicare Advantage by Race, Ethnicity, and Sex.”