There are several demographic and socioeconomic differences between individuals who select traditional Medicare coverage versus Medicare Advantage plans before they turn 65 and who have commercial insurance, according to a new study from researchers at Harvard Medical School and software firm Inovalon.
The study was published July 6 and uses datasets from Inovalon that covers about 30 percent of the country's privately insured population, including employer-sponsored, individual ACA, and MA plans. The second dataset is from CMS and contains 100 percent of the medical and pharmacy claims for all traditional Medicare beneficiaries, along with enrollment data for all Medicare and MA members. The third dataset is sourced from data marketing firm Acxiom and tracks SDOH to a ZIP code level across 30 million geographic areas.
Using the three datasets, the study used a sample of beneficiaries who turned 65 between 2015 and 2019. The data was limited to those who enrolled in Medicare within three months of turning 65, were enrolled in the same plan for at least one year, and were not also enrolled in a D-SNP or commercial plan. The final sample included more than 180,000 individuals who enrolled in traditional Medicare and more than 25,000 individuals who enrolled in MA at age 65.
Six key takeaways:
1. MA is slightly more likely to see male enrollees. MA enrollees also are twice as likely to be non-white and are much more likely to be Black, Hispanic or Asian.
2. MA enrollees are more likely to live in the Northeast and Midwest, while traditional enrollees are more likely to live in the South or West regions. MA enrollees are also more likely to live in an urban area, slightly more likely to live in a suburban area and much less likely to live in a rural area.
3. MA enrollees were over 50 percent more likely than traditional enrollees to have been enrolled in an HMO plan before they were 65.
4. MA enrollees are more likely to have no more than a high school education. They are also less likely to own their home, to be married or to own a vehicle, and they are more likely to have difficulty speaking English.
5. The average income of a traditional enrollee is $85,085, compared to $76,720 for an MA enrollee.
6. Immediately prior to enrollment, those with MA are less sick than traditional enrollees, with about 10 percent lower hierarchical condition category risk scores.