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

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

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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