Top Medicare Plans Scarce in Disadvantaged Areas

Looking for a Medicare Advantage plan with a five-star quality rating? You’re less likely to find one available to you if you live in a county with higher poverty and unemployment rates, according to a new study Published in JAMA Open Network.

According to the researchers, these geographic disparities may contribute to unequal health outcomes and limit federal funds from reaching areas of greatest need.

“This means that Medicare beneficiaries who live in more socially disadvantaged counties have fewer opportunities to choose highly rated Medicare Advantage plans that can provide high-quality care,” said Avni Gupta, a health policy researcher who recently earned her doctorate in health policy and management from New York University’s School of Global Public Health and is now at the Commonwealth Fund.

More than half of all Medicare beneficiariesNearly 31 million people—Enroll in Medicare Advantage plans, rather than choosing traditional Medicare. Medicare Advantage plans, also known as Part C, are offered by private health insurance companies that contract with Medicare and typically combine hospital, outpatient, and prescription drug coverage.

To help consumers compare the quality of Medicare Advantage programs, the Centers for Medicare & Medicaid Services (CMS) uses a five-star rating system, calculating scores based on nearly 40 indicators.

“The goal of the star ratings is to capture the performance of Medicare Advantage plans over the past years, with better ratings indicating higher quality of care in areas such as chronic care management, screenings, immunizations and other preventive services, timely appointments, care coordination, customer service, and handling of appeals,” said Gupta, the study’s lead author.

In addition, star ratings determine the bonuses and rebate payments that insurers receive from CMS; larger payments for higher-rated plans can translate into better supplemental benefits for beneficiaries.

As enrollment in Medical Advantage plans grows each year—and, in particular, enrollment rates among low-income black and Latino adults have risen in recent years—Gupta and her colleagues sought to understand whether quality ratings differ based on where one lives.

Using the 2023 Medicare Advantage ratings — which range from the highest ratings (4.5 or 5 stars) to the lowest ratings (less than 3.5 stars) — the researchers mapped plan availability in 3,075 U.S. counties. They also looked at county-level characteristics using the Centers for Disease Control and Prevention’s Social Vulnerability Index, a calculation of 16 social determinants of health, including poverty, unemployment, education, disability, race and ethnicity, English proficiency, housing and access to transportation.

The researchers found that Medicare Advantage plans in the most disadvantaged counties were less likely to have high ratings (4.5 stars or higher) and more likely to have low ratings (3.5 stars or lower).

“Our findings suggest that beneficiaries who would benefit most from supplemental benefits may only be able to choose among plans that are less likely to have the financial resources to provide these benefits, since lower star ratings translate into lower plan premiums and discounts,” Gupta added. “This pattern of star ratings and social vulnerability at the county level may exacerbate inequalities in health care access, experience, and outcomes.”

The researchers suggested that Medicare policies that take into account area-level weaknesses in the star rating system or incentivize plans that serve such areas could help promote equity.

In addition to Gupta, the study authors include Jose Pagan and Diana Silver of NYU’s School of Global Public Health, Sherry Gleed of NYU’s Robert F. Wagner Graduate School of Public Service, and David Myers of Brown University’s School of Public Health.