Clinical Report: Comparative Analysis of Health Care Access and Equity in Medicare Advantage Versus Traditional Medicare

Overview

This study evaluates disparities in healthcare access and utilization between Medicare Advantage (MA) and Traditional Medicare (TM) among Hispanic, Black, and White beneficiaries.

Background

Disparities in healthcare access and utilization among Medicare beneficiaries are significant, with racial and ethnic minorities facing greater barriers. Understanding these disparities is crucial for ensuring that all beneficiaries receive appropriate care. The rise of Medicare Advantage as a predominant insurance option necessitates an examination of its effects on access and utilization across different demographic groups.

Data Highlights

Key Findings

• White beneficiaries showed a greater relative reduction in discretionary procedures in MA compared to TM.
• Black and Hispanic beneficiaries experienced greater reductions in ED visits and hospitalizations in MA than White beneficiaries.
• MA enrollment is associated with fewer discretionary procedures and lower hospitalization rates.
• Disparities in access to care are influenced by structural, cultural, and individual factors.

Clinical Implications

Healthcare providers should be aware of the potential disparities in access and utilization of services among different racial groups within Medicare Advantage. Understanding these dynamics can inform care management strategies and improve health equity.

Conclusion

The findings highlight the relationship between Medicare Advantage and healthcare utilization disparities.

Related Resources & Content

1. Kaiser Family Foundation (KFF), Medicare Advantage in 2026: Enrollment Update and Key Trends
2. retinal physician, Coding Q&A: Part C Medicare vs Traditional Medicare
3. JAMA Network Open, Medicare Advantage Plans Managed by Hospitals: Impact on Care Utilization and Patient Outcomes Following Inpatient Admissions
4. JAMA Network Open, Access to Specialty Cancer Care and Plan Disenrollment Among Medicare Beneficiaries
5. 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) | CMS
6. Health Care Utilization and Equity in Medicare Advantage Compared With Traditional Medicare | Health Policy | JAMA Network
7. Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain | KFF
8. 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) | CMS
9. Health Care Utilization and Equity in Medicare Advantage Compared With Traditional Medicare | Health Policy | JAMA Network Open | JAMA Network
10. Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain | KFF