Association of Social Vulnerability and Access to Higher Quality Medicare Advantage Plans.

Abstract

Background: With more than half of all beneficiaries enrolled in Medicare Advantage (MA) plans, ensuring access to high-quality MA plans is a key concern for policymakers. Access to high-quality MA plans may be limited in certain areas if private insurers are not willing to offer high-quality MA plans in local areas with greater unmet health-related social needs.

Objective: This study examined the association of a market-level social vulnerability index (SVI) score with the number of high-quality MA plans.

Design: This study conducted a retrospective cross-sectional study.

Participants: Our analysis included 3113 USA counties in 2020.

Main measures: Our primary outcome measure, the availability of high-quality MA plans at the market level, was defined by counting the raw number of 5-star plans, plans with 4.5 or higher stars, and plans with 4 or higher stars. We also counted the number of all MA plans at the market level as an outcome measure to explore private insurers' market entry and participation decisions.

Results: We found evidence that fewer high-quality MA plans are available in markets with greater unmet social needs (higher SVI scores). Compared to the least vulnerable markets, the most vulnerable markets had 1.5 fewer MA plans overall [95%CI -2.9, -0.1]. The most vulnerable markets also had 1.1 fewer 4 or higher star plans [95%CI -1.9, -0.3] than the least vulnerable markets. Furthermore, this negative association was concentrated in the southern region, which has a greater proportion of Black/African Americans in its market-level populations.

Conclusion: As historically marginalized groups are more likely to reside in markets with greater unmet social needs, disparities in access to high-quality MA plans may widen existing health disparities. Therefore, monitoring the availability of high-quality MA plans in areas with greater unmet social needs is needed to improve health equity for MA beneficiaries.