Addressing Health Disparities
In the United States, men consistently experience worse health outcomes than women.[i] Compared to women, men have shorter life expectancies (almost 6 years shorter than women’s in 2022), and are burdened by a higher rates of chronic disease and obesity.[ii] This male health disparity is even more pronounced for men of color, with Black and Native American men experiencing some of the most persistently poor health metrics of any demographic in the United States.
Black men suffer disproportionately from chronic illness, have poorer prognoses, and are diagnosed later than other ethnic group.[iii] Additionally, the burden of risk factors for chronic disease is substantially higher among Black men.[iv] For example:
- Black men are nearly twice as other men to develop Type 2 diabetes[v];
- Black men with cardiovascular disease are twice as likely as other men to die prematurely[vi]; and
- Black men’s risk of having a stroke is 80 percent higher than the general male population.[vii]
These disparities persist across the entire course of life, and older Black men face equally poor and worsening health outcomes as they age. This is due to a variety of factors, including health care systems and programs that are not designed specifically for the needs of males and by the racial biases that exist in society and the healthcare system.
The impact of these biases on the health of Black men compounds over time, meaning that poor health outcomes early in life can lead to even worse outcomes later.[viii] Older Black adults consistently exhibit a higher prevalence of chronic conditions and disability compared to older White adults.[ix] Notably, older Black men are:
- More likely than any other racial or gender subgroup to die after surgery[x],
- More than twice as likely than older White men to die from complications related to diabetes[xi],
- Twice as likely to suffer from Alzheimer’s or other dementias as older White men[xii]
These statistics have major implications for the health and longevity of this population. According to a report published in 2020 by the Department of Health and Human Services (HHS), at age 65, the life expectancy for Black men was a full two years less than the overall average for men.[xiii] The disparate mortality rates among older Black men highlights the urgent need for targeted interventions and policies to overcome barriers to health.
Those barriers include persistent medical mistrust rooted in historical experience, lack of access to high quality health care providers, unaffordable cost of care, and medical debt.[xiv] Interventions aimed at meaningfully improving outcomes for the older Black male population must reflect the complex dynamics that impact this population’s health and longevity and therefore, must be targeted, tailored, and comprehensive enough to adequately address structures that influence health outcomes and access to care.
To that end, this research brief explores the contrast between the two Medicare options accessible to older Americans (traditional fee-for-service Medicare and Medicare Advantage) and provides a detailed overview of how Medicare Advantage’s unique benefits could support efforts to achieve health equity—particularly for older men of color, and especially for those managing chronic conditions.
Unique Benefits of Medicare Advantage
Overview of Medicare Advantage
Today, Medicare provides health care to more than 62 million Americans: 54 million older adults (aged 65 years and older) and 8 million younger adults with disabilities.[xv] Of these beneficiaries, 5.8 million are Black (10 percent of all enrollees).[xvi] Individuals who are eligible for Medicare have the option to enroll in either the federally administered traditional fee-for-service (FFS) Medicare program or they can choose from a range of Medicare Advantage (MA) plans. These MA plans, which are approved by Medicare, offer alternative coverage options from a variety of plan providers.[xvii]
Traditional Medicare was first established in 1965. In 1997, Medicare Advantage was introduced as an alternative option and has seen a steady increase in enrollment. In 2022, nearly half (46 percent) of all Medicare beneficiaries were enrolled in MA plans, with this numbers expected to grow over the next several years.[xviii] Enrollment numbers are even higher among beneficiaries of color, with 49 percent of Black adults choosing to enroll in an MA plan in 2019, and racial minorities making up a larger share of the Medicare Advantage population than they do in traditional Medicare (32 percent vs. 21 percent in 2019).[xix] Further, between 2013 and 2019 alone, enrollment in MA among minority beneficiaries grew by 111 percent.[xx]
Several factors may be driving the growing popularity of MA plans among older adults of color, and exploring these factors will highlight how Medicare Advantage may be better positioned than FFS Medicare to support this population. MA plans may be particularly helpful for older Black men who are disproportionately burdened by a range of chronic conditions.
A Payment Structure that Supports Comprehensive, “Whole Person” Care
Comprehensive and streamlined care is critical for addressing health disparity gaps, such as those observed in the rates and severity of chronic diseases among older men of color. Compared to the FFS model in traditional Medicare, the payment structure of Medicare Advantage may be better able to support the kind of tailored, whole-person care that is needed to address health disparities and promote more equitable health outcomes.
While the FFS model pays healthcare providers based on individual costs associated with each service provided, MA plans operate within a capitated payment structure, whereby plans receive monthly payments from the Centers for Medicare & Medicaid Services (CMS) based on the estimated cost of providing a broad range of medical services and benefits to patients, while also considering the health and anticipated needs of each beneficiary enrolled in the plan. Fundamentally, this process requires that MA plans consider and account for the full range of potential healthcare needs and services that their beneficiary population might require to ensure adequate resources for coverage of even the most high-need beneficiaries. This in turn encourages more comprehensive, thoughtful, coordinated care, that may be especially meaningful to older Black men. Further, this approach is well-suited for addressing the intricate care requirements of beneficiaries who are managing chronic conditions, which disproportionately impact older men of color.[xxi]
Enhanced Care Coordination
Despite having higher rates of chronic conditions and health complications, Black men are far less likely to access and utilize health care services than White men or any group of women.[xxii] This population is particularly affected by the impact of social determinants of health (SDOH) and systematic barriers, resulting in reduced access to services and an increased risk of poor health outcomes.[xxiii] Medicare Advantage offers services and programs that help to enhance care coordination and ensure that beneficiaries have uninterrupted access to essential healthcare services, which can be especially helpful for populations that face higher barriers to accessing needed care. [xxiv] Through MA, beneficiaries can choose to enroll in plans that have reduced out-of-pocket expenses and provide patients with an efficient approach to accessing necessary health care, with tailored services that support chronic disease management. [xxv]
Research shows that consistent and comprehensive access to care is associated with positive health outcomes, and is, therefore, essential for chronic condition management.[xxvi] And promisingly, Black adults enrolled in Medicare Advantage are more likely to have a usual source of care and to report receiving routine health services, including flu shots, blood pressure screenings, and cholesterol checks, as compared to those enrolled in traditional Medicare.[xxvii]
Special Needs Plans for Individuals with Chronic Conditions
Special Needs Plans (SNPs) are a type of coordinated care plan provided under Medicare Advantage. These plans are specifically customized to address the distinct healthcare needs of the most vulnerable Medicare beneficiaries, such as those who are dually eligible for Medicare and Medicaid, have certain medical conditions, or live in institutional settings.[xxviii]
In particular, Medicare Advantage offers Chronic Condition Special Needs Plans (C-SNP) that are built for the unique health care needs of someone with a chronic condition. This type of plan offers beneficiaries with chronic conditions more complete, targeted care than traditional Medicare.[xxix] MA enrollment data show that these plans are highly beneficial for individuals of color who experience comparatively higher prevalence rates of chronic conditions than their white counterparts.[xxx] The reliable care provided by plans like C-SNPs can prove vital for older Black men who experience higher rates of chronic health issues than any other subgroup, and can play a significant role in supporting improved health outcomes for this group that is disproportionately burdened by a range of conditions and medical complications.
Supplemental Benefits that Cover Essential Services
In addition to coordinated care plans, nearly all Medicare Advantage plans (99 percent) cover supplemental benefits such as vision, dental, hearing, telehealth, and/or general wellness/fitness. In recent years, these plans have expanded their supplemental coverage to include programs designed to address the SDOH through community-based programming.[xxxi]
Coverage of supplemental benefits can play a particularly vital role in enhancing health equity for older Black men, a group that faces higher rates of chronic illnesses and health complications. By covering supplemental benefits at little to no extra cost to the beneficiary, MA plans deliver more comprehensive care and services, and are thus better able to address the adverse effects associated with the social determinants of health that often lead to disproportionately poorer health outcomes.
Additionally, supplemental benefits cover a wide array of essential services that assist with chronic condition management. For example, Medicare advantage offers supplemental vision services that can help manage complications brought on by chronic illness, including diabetes.
Access to Home Health and Telehealth
Medicare Advantage plans are increasingly incorporating two additional benefits, namely home health and telehealth services, into their coverage options.[xxxii] During the pandemic, older Black Americans enrolled in a Medicaid or Medicare program had the highest rates of telehealth usage, underscoring the utility of these programs for this demographic.[xxxiii] Research from Penn Medicine indicates that from January to June 2020, telehealth increased the post-discharge primary care completion rate from 52 to 70 percent in Black patients, demonstrating the potential of telehealth to bridge long standing health-inequities.[xxxiv] As access to care is a crucial factor in promoting health equity and better outcomes, these services could play a significant role in addressing longstanding disparities.[xxxv]
Real World Impacts
Comprehensive comparative analyses have demonstrated that Medicare Advantage outperforms traditional Medicare in other outcome measures—many of which are particularly relevant to the older Black male population. For example:
- Medicare Advantage was found to have a 43 percent lower rate of avoidable hospitalizations compared to traditional Medicare— among groups with complex chronic conditions the gap is even greater. Medicare Advantage’s avoidable hospitalization rate for individuals with complex chronic conditions was 57 percent lower than the rate for traditional Medicare.[xxxvi]
- Compared to traditional Medicare beneficiaries, MA enrollees have fewer medical visits overall, suggesting reduced need for medical services over the long run and better health overall.[xxxvii]
- MA plans may also outperform traditional Medicare in disease management. A 2022 report found that for individuals with diabetes, MA beneficiaries were more likely to be recommended guideline-based therapy, take medication to treat their condition, and exhibit improved clinical care outcomes compared to those in traditional Medicare.[xxxviii]
Additionally, Medicare beneficiaries with at least one chronic condition were 55 percent more likely to choose Medicare Advantage over traditional Medicare and the likelihood of choosing MA was even higher among beneficiaries with multiple chronic conditions.[xxxix] For instance, those with three or four chronic conditions were 75 to 80 percent more likely to enroll and those with five or more chronic conditions were 70 percent more likely to enroll in Medicare Advantage.[xl]
Moving Forward: Implications for Policy Decisions
For many years, stakeholders and decisionmakers have recognized the critical impacts that health inequities and disproportionate disease burden have on minority populations in the United States. Medicare Advantage (MA) has increasingly proven to be a preferred option among beneficiaries of color and the unique elements associated with MA plans have the potential to help address some of the critical issues that are currently impeding the improvement of health outcomes for older adults of color, including older Black men. To that end, it is critical that this essential coverage option continues to be protected.
In recent weeks, the Administration released its 2024 Medicare Advantage and Part D Advanced Notice. Among other changes, the Notice proposes an overhaul of the risk adjustment model for MA plan, which if finalized, would remove nearly 2,300 diagnostic codes for conditions such as major depressive disorder, diabetes with chronic conditions, vascular disease, rheumatoid arthritis, and inflammatory tissue disorders.[xli] The proposed codes for elimination include many conditions that are disproportionately prevalent among older Black men. In addition, the reduced payments to physicians who care for Medicare Advantage beneficiaries could mean a reduction in rural and inner-city clinics, further compounding health inequities.[xlii]
Given this context—and the fact that older minority adults are increasingly choosing Medicare Advantage over FFS Medicare—these changes have the potential to be disproportionately harmful for older adults of color, millions of whom rely on benefits provided through MA plans. As policymakers consider changes to Medicare Advantage payment policies, it is critical that those changes do not jeopardize the health of marginalized groups or worsen the significant health inequities that millions of Americans face today. The current proposal falls short of these objectives.
Photo by National Cancer Institute on Unsplash
[i] https://www.health.harvard.edu/newsletter_article/mars-vs-venus-the-gender-gap-in-health#:~:text=The%20health%20gap,likely%20to%20have%20aortic%20aneurysms.
[ii] https://www.health.harvard.edu/newsletter_article/mars-vs-venus-the-gender-gap-in-health#:~:text=The%20health%20gap,likely%20to%20have%20aortic%20aneurysms.
[iii]https://books.google.com/books?hl=en&lr=&id=9S4oDwAAQBAJ&oi=fnd&pg=PP1&ots=F_lFGlsjb5&sig=XiO30YZB6zJ8-wSo6sq506w0gqU#v=onepage&q&f=false
[iv] https://jamanetwork.com/journals/jama/fullarticle/185235
[v] https://www.ahajournals.org/doi/10.1161/CIR.0000000000000558
[vi] https://ftp.cdc.gov/pub/publications/mens_atlas/00-atlas-all.pdf.
[vii] https://www.ahajournals.org/doi/10.1161/CIR.0000000000000558
[viii] https://www.npr.org/sections/health-shots/2021/05/18/996577905/racism-derails-black-mens-health-even-as-education-levels-rise
[ix] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809332/
[x] https://www.bmj.com/content/380/bmj-2022-073290
[xi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319245/
[xii] https://www.alz.org/alzheimers-dementia/facts-figures
[xiii] https://acl.gov/sites/default/files/Profile%20of%20OA/AAProfileReport2021.pdf
[xiv] https://bettermedicarealliance.org/news/report-half-of-latinx-black-medicare-beneficiaries-choose-medicare-advantage/
[xv] https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/mcradvpartdenroldata
[xvi]https://www.google.com/search?q=how+many+black+seniors+are+covered+by+medicare&oq=how+many+black+seniors+are+covere&aqs=chrome.1.69i57j33i160.6755j1j4&sourceid=chrome&ie=UTF-8
[xvii] https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health-plans/medicare-advantage-plans
[xviii] https://www.chartis.com/insights/medicare-advantage-enrollment-continues-surge-increasingly-complex-and-competitive
[xix] https://bettermedicarealliance.org/publication/comparing-the-demographics-of-enrollees-in-medicare-advantage-and-fee-for-service-medicare/
[xx] https://bettermedicarealliance.org/publication/comparing-the-demographics-of-enrollees-in-medicare-advantage-and-fee-for-service-medicare/
[xxi] https://www.fiercehealthcare.com/payer/medicare-advantage-plans-achieve-better-outcomes-than-traditional-medicare-bma-analysis-finds
[xxii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531286/
[xxiii] https://ncba-aging.org/wp-content/uploads/2023/01/PRINT_NCBA_PolicyBrief_R01.pdf
[xxiv] https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-0935-0
[xxv] https://www.retireguide.com/medicare/medicare-advantage-plans/coordinated-care-plans/
[xxvi] https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-primary-care#cit2
[xxvii] https://bettermedicarealliance.org/wp-content/uploads/2021/06/BMA_2021-Q2-Data-Brief_6.15.21.pdf
[xxviii] https://www.retireguide.com/medicare/medicare-advantage-plans/coordinated-care-plans/snp/
[xxix] https://bettermedicarealliance.org/blog-posts/medicare-advantage-is-closing-the-health-disparities-gap-for-seniors/
[xxx] https://www.commonwealthfund.org/blog/2022/taking-stock-medicare-advantage-special-needs-plans
[xxxi] https://www.medicare.gov/coverage/dental-services
[xxxii] https://www.fiercehealthcare.com/payers/milliman-home-benefits-surge-popularity-among-medicare-advantage-plans
[xxxiii] https://www.healthcareitnews.com/news/hhs-study-shows-fewer-video-visits-older-patients-people-color
[xxxiv] https://www.pennmedicine.org/news/news-releases/2022/may/racial-gap-in-completed-doctor-visits-disappeared-in-2020-as-telemedicine-adopted
[xxxv] https://www.annualreviews.org/doi/10.1146/annurev-publhealth-090519-093711#:~:text=Fortunately%2C%20the%20emergence%20of%20telemedicine,of%20each%20of%20its%20components.
[xxxvi] https://www.healthaffairs.org/sponsored-content/value-of-medicare-advantage-5
[xxxvii] https://www.kff.org/medicare/report/beneficiary-experience-affordability-utilization-and-quality-in-medicare-advantage-and-traditional-medicare-a-review-of-the-literature/
[xxxviii] https://www.kff.org/medicare/report/beneficiary-experience-affordability-utilization-and-quality-in-medicare-advantage-and-traditional-medicare-a-review-of-the-literature/
[xxxix] https://bettermedicarealliance.org/wp-content/uploads/2020/03/BMA_ThorpeReport_2018_09_13.pdf
[xl] https://bettermedicarealliance.org/wp-content/uploads/2020/03/BMA_ThorpeReport_2018_09_13.pdf
[xli] https://www.apg.org/news/apg-statement-on-2024-medicare-advantage-and-part-d-advance-notice/
[xlii] https://www.apg.org/news/apg-statement-on-2024-medicare-advantage-and-part-d-advance-notice/
