Ensuring High-Quality Care in Medicare Advantage and Traditional Medicare: Examining Heterogeneity of Program Effects

University Of Michigan At Ann Arbor, Ann Arbor MI

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Abstract

The Medicare Advantage (MA) program has experienced substantial growth over the last decade, particularly among older adults with varied incomes and socioeconomic circumstances. MA offers an alternative to traditional Medicare (TM) coverage by allowing Medicare beneficiaries to receive integrated medical and prescription drug coverage from private insurers. While MA serves a broad range of enrollees, further evidence is needed to understand differences in plan performance and care outcomes, and the extent to which quality of care differs between MA and TM and among different MA plans for enrollee subgroups. These differences are important to study as MA plans, both individually and relative to TM, differ on several dimensions, including cost-sharing, provider networks, utilization management, and supplemental benefits, that can affect care for enrollees. Therefore, the overarching objectives of this study are to 1) investigate whether MA vs. TM enrollment is associated with differences in access, quality, and utilization of care relative to TM among demographic and socioeconomic subgroups of enrollees; 2) to identify within- and across-plan differences in MA plan quality and identify high-performing MA plans that consistently deliver strong outcomes across multiple settings and beneficiaries; and 3) to develop and validate patient-reported measures assessing the quality, consistency, and reliability of care delivery. We draw on rich sources of national data, including the Medicare Current Beneficiary Survey and encounter claims submitted by Medicare Advantage plans, and will also conduct a national survey of Medicare beneficiaries to assess patient-reported experiences of care access and quality. These findings will inform future evaluations of MA plan performance (e.g., star ratings) and help refine approaches for comparing care quality across plans. The work aligns with federal goals to ensure all Medicare beneficiaries receive effective, efficient care. Results will be disseminated via peer-reviewed publications and briefings to key health policy stakeholders.