Abstract
Medicare beneficiaries with disabilities aged 18 to 64 years face barriers accessing ambulatory care. Past studies comparing Medicare Advantage (MA) with traditional Medicare (TM) have not assessed how well these programs meet the needs of beneficiaries with disabilities. To compare differences in enrollment rates, ambulatory care access, and ambulatory care quality for beneficiaries with disabilities in MA vs TM. This cohort study included a nationally representative, weighted sample of 7201 person-years for beneficiaries aged 18 to 64 years with disability entitlement in the Medicare Current Beneficiary Survey from 2015 through 2018. Differences in program enrollment and in measures of access and quality by program enrollment were compared after adjusting for demographic, insurance, social, health, and area characteristics and after reweighting the sample by propensity to enroll in MA as estimated by observed confounders. Data analyses were conducted between November 1, 2020, and November 11, 2021. Medicare Advantage vs TM program enrollment. Six patient-reported measures of ambulatory care access (usual source of care, primary care usual source of care, specialist visit) and quality (cholesterol screening, influenza vaccination, colon cancer screening). The mean (SD) age of the overall study population was 52.1 (11.0) years; 49.5% were female and 50.5% were male; 1.6% were Asian/Pacific Islander; 17.4%, Black; 10.2% Hispanic; 1.4%, Native American; 65.1%, White, and 4.2%, multiracial. Among all beneficiaries living in the community, individuals with disability entitlement were less likely to enroll in MA than other beneficiaries (34.8% vs 41.2%). The final sample of beneficiaries with disabilities included 2444 person-years in MA and 4757 person-years in TM. Beneficiaries with disabilities in MA vs TM were more likely to be of a minority race or ethnicity (35.7% vs 27.6%) and less likely to be enrolled in private insurance (11.9% vs 25.0%). Comparing MA with TM among beneficiaries with disabilities, those in MA had significantly better rates of access to a usual source of care (90.2% vs 84.9%; adjusted propensity-weighted marginal difference [APWMD], 2.9%; 95% CI, 0.2%-5.7%), access to specialist visits (53.2% vs 44.8%; APWMD, 5.5%; 95% CI, 0.6%-10.5%), cholesterol screenings (91.1% vs 86.4%; APWMD, 3.8%; 95% CI, 0.9%-6.7%), influenza vaccinations (61.4% vs 51.5%; APWMD, 10.4%; 95% CI, 5.3%-15.5%), and colon cancer screenings (68.4% vs 54.6%; APWMD, 10.3%; 95% CI, 4.8%-15.8%). In this cohort study, Medicare beneficiaries with disabilities were enrolled in MA at significantly lower rates than those without disabilities. However, MA was associated with significantly better ambulatory care access and quality for these beneficiaries on 5 of 6 measures compared with TM.
Highlights
Medicare beneficiaries with disabilities aged 18 to years comprise 15% of the Medicare population and experience considerable disparities in access to care compared with beneficiaries aged years or older.[1,2] access to care for this vulnerable population has been understudied
Medicare Advantage (MA) was associated with significantly better ambulatory care access and quality for these beneficiaries on 5 of 6 measures compared with traditional Medicare (TM)
Medicare beneficiaries with disabilities may enroll in the traditional Medicare (TM) program administered by the Centers for Medicare & Medicaid Services (CMS) or in private Medicare Advantage (MA) plans
Summary
Medicare beneficiaries with disabilities aged 18 to years comprise 15% of the Medicare population and experience considerable disparities in access to care compared with beneficiaries aged years or older.[1,2] access to care for this vulnerable population has been understudied. Medicare beneficiaries with disabilities may enroll in the traditional Medicare (TM) program administered by the Centers for Medicare & Medicaid Services (CMS) or in private Medicare Advantage (MA) plans. Medicare beneficiaries with disabilities report greater difficulty accessing care and are less likely to receive needed preventive care than are other beneficiaries.[3,4,5,6,7,8] Traditional Medicare beneficiaries with disabilities aged 21 to 64 years are 33% and 49% less likely to have access to primary care clinicians (PCCs) and specialists, respectively, than are beneficiaries without disabilities.[2] Lack of access to high-quality ambulatory care is associated with negative clinical outcomes.[2,9,10,11]
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