How Medicare Eligibility Impacts Racial Coverage Disparities

Medicare eligibility may reduce racial and ethnic disparities in healthcare coverage, according to a JAMA Network study.

The researchers used the Behavioral Risk Factor Surveillance System and the state-age-year observations in the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research Data. Specifically, they leveraged data spanning from 2008 through 2018.

The study analyzed over 2.4 million seniors, including over 192,000 Black participants and more than 104,000 Hispanic participants.

When comparing seniors older than the Medicare age of eligibility with seniors younger than the age of Medicare eligibility, the healthcare coverage gap between Black people and White people fell by 53 percent. 

Before attaining Medicare eligibility, the healthcare coverage gap between Black individuals and White individuals was 5.7 percent. After attaining Medicare eligibility, the healthcare coverage gap between Black beneficiaries and White beneficiaries dropped to around 2.7 percent.

The healthcare coverage gap between White beneficiaries and Hispanic beneficiaries also dropped by more than half (51 percent) from a 14.6 percent healthcare coverage gap to a 7.2 percent healthcare coverage gap.

Hispanic individuals and White individuals also experienced more equal access to care after achieving Medicare eligibility. Before Medicare eligibility, Hispanic individuals experienced cost-related barriers to care at a rate 11.4 percent higher than their White counterparts. After attaining Medicare eligibility, however, this gap shrank to 6.9 percent.

Compared to White communities, Black communities did not have a significantly different experience of access to usual sources of care. Black individuals’ cost-related barriers and influenza vaccination rates were within two percent of their White counterparts’ barriers and vaccination rates.

The biggest reductions in both healthcare coverage and access to care disparities occurred in states with the biggest racial and ethnic healthcare disparities. Additionally, shifts in healthcare coverage, access to care, and patient outcomes were higher in states that had high uninsurance rates, specifically in southern states.

While the data highlighted the positive influence that Medicare coverage can have on reducing disparities, beneficiaries still faced racial and ethnic disparities after attaining Medicare eligibility. Social determinants of health such as structural racism still can impact healthcare coverage rates and access to care for seniors.

“The persistence of self-reported health disparities may reflect secular trends that complicate pre- and post-ACA comparisons or suggest that immediate improvements in self-reported health at age 65 years reflect short-run gains that are associated with changes in perception because of individuals being newly insured,” the study stated. 

“However, the disparity between White and Black adults in cost-related barriers to care was substantially reduced post-ACA, and Medicare eligibility was not associated with a further closure of the gap.”

The Affordable Care Act did not impact these trends significantly, the study found. Beneficiaries in states that embraced Medicaid expansion also experienced racial care disparities.

The researchers noted that state-level patterns might not reflect nationwide trends. Additionally, life changes that coincide with achieving Medicare eligibility might have had some influence on the results.

This study did not address potential differences between original Medicare beneficiaries and Medicare Advantage plan beneficiaries. 

However, separate data showed that Medicare Advantage plans may be more effective at reducing care disparities compared to original Medicare. Around half of all Black Medicare beneficiaries are in Medicare Advantage and over half of all Latinx Medicare beneficiaries are enrolled in a Medicare Advantage plan.

Medicare Advantage beneficiaries have higher healthcare utilization than those in original beneficiaries, the separate data found.

Still, racial coverage disparities persisted from 2010 through 2019, even with the Affordable Care Act in place.

In order to reduce care disparities, payers and healthcare experts have recommended incorporating health equity measures into quality measures for health plans.