A recent cross-sectional study published in JAMA Network Open has uncovered a significant Medicare Advantage (MA) quality gap for beneficiaries depending on where they live.
The research, conducted by a team led by Avni Gupta from New York University, examined the relationship between a county’s social vulnerability and the star ratings of MA plans offered in that area.
The 5-star rating system, which is used by the Centers for Medicare & Medicaid Services, measures the quality of these private plans across nearly 40 indicators, spanning domains such as preventive care, chronic disease management, patient experience, customer complaints, customer service, and drug safety and pricing.
The study uncovered that counties with higher social vulnerability, measured by factors such as poverty, unemployment, disability rates and housing conditions, tended to have MA plans with lower star ratings. In the most vulnerable counties, the average star rating was 3.8 out of 5, compared to 4.1 in the least vulnerable counties.
Perhaps more concerning, the researchers discovered that the most socially vulnerable counties had 25% fewer of the highest-rated plans (those with 4.5 stars or above) compared to the least vulnerable areas. This pattern held true across all aspects of social vulnerability examined in the study.
These findings suggest that MA beneficiaries living in more disadvantaged areas may have fewer options for high-quality health coverage. This could potentially worsen existing health disparities, as higher-rated plans are often associated with better health outcomes and more comprehensive benefits.
Gupta and colleagues argue that these results should prompt policymakers to consider how the current star rating system might be adjusted to account for social vulnerability. They suggest that plans serving more vulnerable populations might need additional support to achieve higher ratings and provide better care to their members.
As the number of Americans enrolled in MA continues to grow, especially in socially vulnerable areas, addressing these disparities becomes increasingly important to ensure equitable access to high-quality healthcare for all seniors.
