Enrollment in Supplemental Insurance Coverage Among Medicare Beneficiaries by Race/Ethnicity.

Abstract

The objective of this study was to examine racial/ethnic differences in enrollment trends for supplemental insurance coverage among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries. We employed a retrospective cohort study design using the 2010-2016 Medicare Current Beneficiary Survey. We included two types of outcomes: 1) seven exclusive types of insurance coverage in a given year and 2) changes in insurance coverage in the next year for those with each of the seven exclusive types of insurance coverage. Our primary independent variable was race/ethnicity. We conducted regression while controlling for demographic, socioeconomic, and health characteristics. We calculated the adjusted value of the outcome by race/ethnicity after adjusting for demographic, socioeconomic, and health status characteristics. We found substantial racial/ethnic differences in supplemental insurance coverage among TM and MA beneficiaries. Compared to White beneficiaries, racial/ethnic minority beneficiaries had lower adjusted rates of enrollment in Medigap among TM beneficiaries and higher enrollment in Medicaid among both TM and MA beneficiaries. Trends in enrollment differed by supplemental insurance coverage, but an increasing trend in enrollment among MA beneficiaries without supplemental insurance coverage and MA beneficiaries with Medicaid was notable. Overall trends were consistent across all racial/ethnic groups. Finally, most beneficiaries were less likely to change insurance coverage in the next year, but a distinct phenomenon was observed among Black beneficiaries with the lowest rates of remaining in Medigap or MA only. Our findings indicate the minority Medicare beneficiaries may not have equitable access to supplemental insurance coverage.