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62 Studies Don't Lie: Little Differentiation Between Medicare and MA

Analysis  |  By Laura Beerman  
   September 20, 2022

With few exceptions, highlights from KFF's review reveal much parity between the programs.

In a review of 62 studies comparing original Medicare and Medicare Advantage (MA), Kaiser Family Foundation (KFF) found "few big differences…on a variety of measures." These measures included beneficiary experience, affordability, service utilization, and quality. KFF noted that these results were based on "strong evidence or [findings that] have been replicated across multiple studies."

The review, summarized in a KFF press release, included studies published since 2016. Among the following findings, KFF noted that "relatively few studies specifically examine … population subgroups," including people of color, rural residents, and dual eligibles.

  1. No real difference—across all quality measures.

    It's one thing to have parity, or differences, on more detailed program components. But perhaps the most notable KFF finding was neither MA nor original Medicare outperformed on quality as a whole. In select measures for heart disease and diabetes management, quality was also similar for blood sugar control, insulin use, receipt of diabetes blood tests, and receipt of "guideline-recommended" heart disease therapies in outpatient settings.

    The differences: More MA enrollees received "guideline-recommended therapies" for inpatient heart disease care and performed better on select diabetes care metrics.
  2. A similar result for multiple patient experience measures.

    KFF's analyses found no differences between original Medicare and MA on four beneficiary experience metrics: wait times, trouble finding a general doctor, and being told that their health insurance was not accepted or that they would not be able to join as a new patient.

    The differences: MA enrollees were more likely to have a usual source of care and to receive needed prescription drugs as well as care transition instructions.
  3. Equal affordability for select patient groups.

    Three of the 62 studies KFF reviewed examined affordability for high-need beneficiaries, including those with diabetes or a mental illness.

    The differences: Fewer original Medicare enrollees with supplemental coverage reported affordability challenges compared to MA, but these results were flipped for Medicare beneficiaries without the added benefits.
  4. Hospital performance parity.

    Across the 62 studies there were "generally no differences" in hospital days or average length of stay for more common admissions.

    The differences: Findings were mixed for Hospital Services utilization, with one cluster of studies finding fewer hospital stays for MA members and two other studies finding no real distinction. Similarly, MA members had lower overall hospital admission rates, but no difference in a cluster of studies focused on a single hospital or procedure. MA hospital readmission rates were higher for heart attack, CHF, and pneumonia.

For a complete comparison of findings, see KFF's complete study.

Laura Beerman is a contributing writer for HealthLeaders.

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