Prevalence of common chronic conditions in Medicare Advantage and traditional Medicare beneficiaries

1. In this cross-sectional study, Medicare Advantage (MA) beneficiaries had a similar prevalence of obesity, hypertension, hyperlipidemia, and chronic kidney disease compared with traditional fee-for-service Medicare beneficiaries

2. The prevalence of diabetes was higher in the MA population versus the fee-for-service Medicare population.

Evidence Rating Level: 3 (Average)

Study Rundown: The majority of Medicare beneficiaries have now been enrolled in Medicare Advantage (MA), a private plan alternative to the traditional fee-for-service (FFS) model. MA plans are paid based on risk scores that consider the health complexity of beneficiaries. Prior analyses have suggested that MA beneficiaries may have higher risk scores than FFS beneficiaries, but it is unknown whether this represents true increased medical complexity among MA beneficiaries or artificial differences caused by “upcoding” encouraged by MA payment. This study aimed to determine whether the prevalence of chronic medical conditions was higher among MA beneficiaries compared with FFS beneficiaries. Beneficiaries under MA did not have significant differences in mean body mass index (BMI), mean systolic and diastolic blood pressure, total cholesterol concentration, or estimated glomerular filtration rate (eGFR) compared with FFS beneficiaries. However, the MA cohort did on average have modestly higher HbA_1c values. Sensitivity analyses showed that in participants aged 65 to 69 years, all five medical conditions studied were higher among MA beneficiaries compared with FFS beneficiaries, although the data may show a high level of uncertainty. The generalizability of this study was limited by an inability to determine differences in the severity of specific medical conditions; the limited range of medical conditions assessed; and the fact that the data assessed were older and may not reflect current realities surrounding MA. Nevertheless, these results suggested that, apart from in diabetes, there were no significant differences in the prevalence of several common medical conditions between MA beneficiaries and traditional Medicare beneficiaries.

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Relevant Reading: Comparing Medicare Advantage And Traditional Medicare: A Systematic Review

In-Depth [cross-sectional study]: This cross-sectional study investigated the prevalence of obesity, hypertension, hyperlipidemia, CKD, and diabetes among MA beneficiaries and FFS beneficiaries. Data were obtained from National Health and Nutrition Examination Survey (NHANES) results between 2015 and 2018. Sensitivity analyses included survey-weighted models standardized across all participant sociodemographic variables as well as analyses within specific groups, such as newer enrollees. A total of 2446 participants, consisting of 1006 MA beneficiaries and 1440 FFS beneficiaries, were included in this study. Beneficiaries under MA were more likely to be female (58.5% vs. 53.5%), less likely to be White (71.7% vs. 81.7%), less likely to have had a college education (22.4% vs. 36.4%), and more likely to have household incomes under the poverty line (11.4% vs. 7.0%) compared with FFS beneficiaries. However, the MA cohort did not have significant differences in mean BMI (29.5 kg/m² vs. 29.3 kg/m²), mean systolic blood pressure (135.0 mm Hg vs. 134.6 mm Hg), mean diastolic blood pressure (66.4 mm Hg vs. 66.5  mm Hg), total cholesterol concentration (4.85 mmol/L vs. 4.87 mmol/L), or eGFR (75.7 mL/min/1.73 m² vs. 73.7 mL/min/1.73 m²) compared with FFS beneficiaries. However, MA beneficiaries did have slightly higher HbA_1c levels compared with FFS beneficiaries (6.1% [95% CI, 6.0% to 6.2%] vs. 6.0% [95% CI, 5.9% vs. 6.0%]). When standardized for age and sex, MA beneficiaries still did not have significant differences in the prevalence of obesity (41.1% vs. 40.6%), hypertension (70.9% vs. 71.0%), hyperlipidemia (79.4% vs. 82.3), or chronic kidney disease (19.2% vs. 22.8%) compared with FFS beneficiaries. However, the prevalence of diabetes remained higher among MA beneficiaries compared with FFS beneficiaries (33.3% vs. 26.3%). Subgroup analyses based on sociodemographic variables showed mostly similar results, except that in patients aged 65 to 69 years, the prevalence of all 5 conditions was higher among MA beneficiaries compared with FFS beneficiaries; however, the confidence intervals for this result were wide. Overall, this study suggested that, while diabetes was more prevalent among MA beneficiaries, the prevalence of several other chronic medical conditions were similar among MA beneficiaries compared to FFS beneficiaries

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