Need a Good Medicare Advantage Plan? They're Tough to Find for Poorer Americans

• July 25, 2024
• Dennis Thompson HealthDay Reporter

Medicare Advantage plans are touted as a great alternative to traditional Medicare, offering seniors easier access to doctors, hospitals and prescription drugs.

But access to a good Medicare Advantage plan relies heavily on where a person lives, a new study finds.

People are less likely to find a five-star Medicare Advantage plan if they live in a U.S. county with higher poverty and unemployment, researchers reported in the journal JAMA Network Open.

These geographic disparities could be keeping federal funds from reaching people most in need, researchers said.

“What this means is that Medicare beneficiaries living in counties with greater social disadvantage have fewer opportunities to choose highly rated Medicare Advantage plans that could be delivering high-quality care,” said lead researcher Avni Gupta, a recent doctoral graduate of health policy and management from the New York University School of Global Public Health.

More than half of all Medicare beneficiaries are enrolled in Medicare Advantage plans, amounting to nearly 31 million people, researchers said in background notes.

To help consumers compare the plans, the U.S. Centers for Medicare & Medicaid Services provide a five-star rating system that calculates scores based on nearly 40 indicators, researchers said.

“Star ratings are meant to capture the performance of Medicare Advantage plans in past years, with better ratings demonstrating higher quality care in areas such as chronic care management, screenings, vaccinations and other preventive services, timely appointments, care coordination, customer service and handling appeals,” Gupta explained in a university news release.

The ratings also determine bonuses and rebate payments that insurance companies receive from CMS. Larger payments to higher-rated plans can translate into better benefits for seniors, researchers said.

For the study, researchers mapped the availability of Medicare Advantage plans in 3,075 counties.

They compared the plans against each county’s poverty, unemployment, education, disability, housing, transportation access and racial/ethnic makeup.

They found that Medicare Advantage plans in the most disadvantaged counties were less likely to have 4.5 stars or higher, and more likely to have ratings of 3.5 stars or lower.

“Our findings imply that beneficiaries who might gain the most from supplemental benefits may only be able to choose from plans that are least likely to have the financial resources to provide these benefits, given that lower star ratings translate to lower bonuses and rebates to insurance plans,” Gupta said.

“Such a pattern of star ratings and county-level social vulnerability could exacerbate inequities in health care access, experience and outcomes,” Gupta continued.

New Medicare policies that account for an area’s vulnerability in the star rating system could help counter these inequities, researchers said. CMS could also consider incentivizing plans to serve such areas.

More information

AARP has more about Medicare Advantage.

SOURCE: New York University, news release, July 23, 2024

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