Medicare Mortality Rates Reveal COVID-19 Racial Care Disparities

While racial care disparities in Medicare are not new, the gap in mortality rates between beneficiaries of different ethnicities and races grew even more pronounced during the coronavirus pandemic, a study from Avalere confirmed.

Medicare beneficiaries should have access to the same benefits and health insurance coverage. Nevertheless, beneficiaries of different races and ethnicities experienced very different health outcomes during the coronavirus pandemic.

The researchers pulled data for this study from the CMS Master Beneficiary Summary File.

From 2015 to 2019, mortality rates differed between races and ethnicities but overall the rates within each racial or ethnic group were stable. For example, the Native American beneficiary mortality rate hovered around 40 deaths per 1,000 beneficiaries from 2015 through 2019 as did the White beneficiary mortality rate.

From 2019 to 2020 the Medicare mortality rate took a huge leap, but some populations saw a higher increase than others. 

While the White beneficiary population saw a 13 percent increase in mortality rates, both the Hispanic and the Native American beneficiary communities saw mortality rates rise 38 percent. The Black population of Medicare beneficiaries experienced a 26 percent increase in the mortality rate and among Asian beneficiaries the mortality rate rose 21 percent.

The differences in Medicare beneficiary outcomes between distinct races and ethnicities were also clear when the researchers factored in age.

Between 2019 and 2020, White Medicare beneficiaries experience little modulation in mortality rates across different age groups. The percent change in the White Medicare beneficiary population under the age of 65 was almost exactly the same as the percent change for White  Medicare beneficiaries ages 85 and older—an increase in mortality of around 12 percent.

In contrast, the Hispanic Medicare beneficiary population saw big swings in mortality rates by age group and between age groups. The mortality rate for Hispanic Medicare beneficiaries ages 85 and older rose 29 percent between between 2019 and 2020 and for those between the ages of 65 and 69, the mortality rate increased by 69 percent.

Asian beneficiaries and Black beneficiaries also saw mortality rates increase across age groups, though the changes were slightly more uniform across the age delineations. Still, in the 75 to 79 age group, Black and Asian Medicare beneficiaries each saw an increase of approximately 30 percent, whereas White beneficiaries saw an increase of around 15 percent.

The report emphasized that mortality is just one dimension through which healthcare stakeholders can see racial care disparities and how lack of health equity has amplified the impact of the coronavirus pandemic.

“Taking the initial step to analyze mortality data closely and explore the potential impacts of COVID-19 on Medicare enrollees provides additional insight into enrollment, healthcare management, and opportunities to reduce mortality rates and mitigate differences among racial/ethnic groups,” the researchers stated.

While the Avalere study shows the shifts that occurred during the coronavirus pandemic that point to care disparities in Medicare, a JAMA Network study suggested that Medicare eligibility may reduce racial and ethnic care disparities.

The coverage gap between White and Black individuals dropped by 53 precent when individuals became eligible for Medicare. The gap between White and Hispanic individuals shrank as well.

Medicare Advantage beneficiaries may see an even lower rate of racial care disparities than fee-for-service Medicare beneficiaries, a Better Medicare Alliance study indicated. Medicare Advantage plans have a higher share of minority beneficiaries than fee-for-service Medicare does. 

Additionally, preventive services utilization among Medicare Advantage beneficiaries was higher than fee-for-service Medicare beneficiaries in every racial group analyzed in the Better Medicare Alliance study. Ten percent more Black beneficiaries received flu shots in Medicare Advantage plans compared to traditional Medicare.

As more data becomes available about the impact of the coronavirus pandemic on health equity, payers are making changes to reduce racial care disparities.