New study analyzes differences in characteristics between beneficiaries as they're transitioning from commercial to Medicare coverage at 65.
MA enrollees have less money and are more susceptible to social risk factors than traditional Medicare members, according to a new white paper by Harvard Medical School and Inovalon.
The study attempted to examine the factors that influence enrollment in MA or fee-for-service (FFS) Medicare at the critical point when beneficiaries are transitioning from commercial to Medicare coverage at the age of 65.
Researchers utilized Inovalon's dataset, which accounts for approximately 30% of the privately-insured population in a given year, as well as a CMS dataset containing the medical and pharmacy insurance claims for all Medicare beneficiaries enrolled in FFS and enrollment data covering all Medicare beneficiaries enrolled in FFS and MA. The third dataset used was Acxiom's files that track social determinants of health (SDOH).
The sample of beneficiaries included those who turned 65 between 2015 and 2019, were enrolled in Medicare within three months of turning 65, were in the same plan for at least 12 months, were not also enrolled in Medicaid or a commercial plan at the same time, and were enrolled in an employer-sponsored health plan for all 12 months before turning 65. With those limitations, the final sample consisted of 180,087 enrollees in FFS and 25,470 beneficiaries in MA at age 65.
What the study uncovered was significant differences in socioeconomic characteristics between MA and Medicare enrollees. The average income of Medicare enrollees was found to be $85,085, compared to $76,720 for those in MA. When it came to net worth, MA enrollees were 74.2% of the average of Medicare enrollees. The divide was consistent with the difference in location—35.5% of Medicare enrollees live in a neighborhood with incomes above $100,000, while that's the case for only 23.8% of MA enrollees.
Further findings included that MA enrollees are twice as likely to be non-white and much more likely to be Black, Hispanic, or Asian. Meanwhile, MA enrollees were 50% more likely to have been enrolled in an HMO plan right before turning 65.
"Historically, it has been challenging to document differences in beneficiaries who enroll in Medicare Advantage versus traditional Medicare at age 65," Christie Teigland, vice president of Research Science and Advanced Analytics at Inovalon, said in a press release. "Our study provides a better understanding of the core customer segments of Medicare Advantage and which beneficiaries are most likely to enroll in which coverage type. This information can help health plans better tailor and target their products to enhance member recruitment and retention and better plan for future resource needs."
As MA continues to grow and overtake Medicare as the primary plan choice for seniors, it's necessary for lawmakers to better understand the MA population to ensure the private program is serving beneficiaries the best it can.
Michael Chernew, health economist and professor at Harvard Medical School and overseer of the study, said: "The findings provide new resources for policymakers and healthcare administrators to improve the delivery of value-based care programs, address health inequities, and improve health outcomes for all beneficiaries."
Jay Asser is the CEO editor for HealthLeaders.
KEY TAKEAWAYS
Innovative research by Harvard Medical School and Inovalon aims to capture how Medicare Advantage and traditional Medicare beneficiaries differ at the age they switch to Medicare coverage.
The study found that the average income and net income of Medicare enrollees was lower, while they were also more likely to be non-white and be enrolled in an HMO plan right before turning 65.