Does the Racial/Ethnic Composition of Medicare Advantage Plans Reflect Their Areas of Operation?

Published In: HSR, Health Services Research, v. 49, no. 2, Apr. 2014, p. 526-545

Posted on RAND.org on August 28, 2013

by Robin M. Weinick, Amelia Haviland, Katrin Hambarsoomian, Marc N. Elliott

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Research Question

  1. Does enrollment of Medicare Advantage plans reflect the composition of the areas in which they operate?

OBJECTIVE: To assess the extent to which the racial/ethnic composition of Medicare Advantage (MA) plans reflects the composition of their areas of operation, given the potential incentives created by the Centers for Medicare & Medicaid Services' Quality Bonus Payments for such plans to avoid enrolling racial/ethnic minority beneficiaries. DATA SOURCES/STUDY SETTING: 2009 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey and administrative data from the Medicare Enrollment Database. DATA COLLECTION/EXTRACTION METHODS: We defined each plan's area of operation as all counties in which it had MA enrollees, and we created a matrix of race/ethnicity by plan by county of residence to assess the racial/ethnic distribution of each plan's enrollees in comparison with the racial/ethnic composition of MA beneficiaries in its operational area. PRINCIPAL FINDINGS: There is little evidence that health plans are selectively underenrolling blacks, Latinos, or Asians to a substantial degree. A small but potentially important subset of plans disproportionately serves minority beneficiaries. CONCLUSIONS: These findings provide a baseline profile that will enable crucial ongoing monitoring to assess how the implementation of Quality Bonus Payments may affect MA plan coverage of minority populations.

Key Findings

  • There is little evidence that Medicare Advantage plans are selectively under-enrolling blacks, Latinos, or Asians.
  • A small subset of plans disproportionately serves minority beneficiaries.

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