Racial and Ethnic Disparities in Preventive and Chronic Disease Care in Medicare Advantage vs. Traditional Medicare.

Abstract

Over half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), with Black and Hispanic beneficiaries disproportionately in MA versus traditional Medicare (TM). To examine Black-White and Hispanic-White disparities in preventive and chronic disease care by MA vs. TM. Cross-sectional propensity-score-weighted difference-in-disparities analyses compared Black-White and Hispanic-White disparities in MA and TM using the Medicare Current Beneficiary Survey (2015-2020). Medicare beneficiaries with cardiovascular disease or risk factors (N = 68,788 person-years). Influenza vaccine, pneumococcal vaccine, blood pressure check, cholesterol test, colorectal cancer screening, preventive care index (count of above; 0-5), mammogram, annual wellness visit; hemoglobin A1C and eye exam. Black and Hispanic, compared to white, beneficiaries were less likely to receive annual wellness visits, influenza vaccines, pneumococcal vaccines, and colorectal cancer screening. Black beneficiaries in MA vs. TM had higher overall preventive care use (preventive care index, 3.67 vs. 3.44) and higher rates of all preventive services examined. Hispanic beneficiaries in MA vs. TM had higher preventive care use (index, 3.67 vs. 3.56), including annual wellness visit, blood pressure check, colorectal cancer screening, and breast cancer screening. Preventive care use was higher among White beneficiaries in MA than TM (index, 3.88 and 3.79). Black-White disparities were smaller in MA than TM for preventive care use (difference-in-disparities: + 0.13 index points, 95% CI 0.04-0.22), blood pressure check (+ 2.2 percentage points [p.p.], 95% CI 0.1-4.4), cholesterol check (+ 2.2 p.p., 95% CI 0.2-4.2), and eye exam (+ 5.0 p.p., 95% CI 1.4-8.7). Hispanic-White disparities were not statistically different in MA vs. TM. Although MA was associated with smaller Black-White disparities in preventive care compared to TM, these differences were modest, and MA was not associated with smaller Hispanic-White disparities.