Medicare Advantage plans see spike in Black, dual-eligible beneficiary enrollment

Medicare Advantage enrollment among Black people, dual-eligibles, and those residing in the most disadvantaged areas outpaced growth of white and non-dual eligibles from 2009 through 2018, according to a Health Affairs study published Tuesday.

While their enrollment in MA plans climbed, beneficiaries in these groups also tended to have lower quality options from which to choose. Assuming the enrollment trend continues, the study predicted that the majority of Black, Hispanic, and dual enrollees will be in a Medicare Advantage plan, as opposed to Medicare fee-for-service, over the next five years. The majority of all Medicare beneficiaries are expected to be in Medicare Advantage within the next 10 years, according to 2020 estimates by the Congressional Budget Office. While this trend corresponds with broader changes in demographics and geographic distribution, the study suggests policymakers look into solutions to the disproportionate coverage.

Enrollment in Medicare Advantage plans grew by 12% from 2009 through 2018. The largest levels of growth appeared in dual eligibles, which rose by 101%. Enrollment of Black beneficiaries came next, with a 66% increase in enrollment over the same period of time. This comes in contrast with white beneficiaries and non-dual enrolled beneficiaries, which increased at a 46% and 43% rate, respectively.

The study also examined rates of Medicare Advantage enrollment across areas ranked by the Social Deprivation Index, which measures the amount of resources in a neighborhood and classifies the region into a high or low quintile. Those in higher quintiles, who represented greater levels of deprivation, were more likely to enroll in Medicare Advantage programs and experienced a 60% relative increase in enrollment. That’s nearly 18% higher than the amount of enrollees in less “deprived” neighborhoods.

Hispanic beneficiaries were most often enrolled in zero-premium (55%) or other low-quality plans. The study also showed that underrepresented and underresourced groups were heavily enrolled in lower quality plans than their White and better resourced counterparts. Some of these lower quality plans, such as the dual-eligible special needs plans, even deny dual enrollees fully integrated Medicaid and Medicare benefits.

One reason for the increased enrollment among underrepresented groups is the expansion of plans with zero premiums and the development of Special Needs Plans. According to the study, these programs create access for a more diverse group of beneficiaries to enroll in Medicare Advantage plans. About 45% of those enrolled in Special Needs plans in 2018 were Hispanic and 55% were dual enrollees. White beneficiaries, who historically have better access to coverage, only used 10% of these plans. But, almost 70% of White beneficiaries were in plans rated four or five stars. That’s 15% more than any other demographic besides those residing in the best resourced areas on the Social Deprivation Index. Their enrollment was close to 74%.

Researchers urged CMS and policymakers to look into areas where increased access and quality coverage can be delivered to underrepresented groups enrolling in Medicare Advantage.