Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults

Amit Kumar, Maricruz Rivera-Hernandez, Amol M. Karmarkar, Lin Na Chou, Yong Fang Kuo, Julie A. Baldwin, Orestis A. Panagiotou, Robert E. Burke, Kenneth J. Ottenbacher

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: We assessed the characteristics of older Mexican American enrollees in traditional fee-for-service (FFS) and Medicare Advantage (MA) plans and the factors associated with disenrollment from FFS and enrollment in MA plans. DESIGN: Longitudinal study linked with Medicare claims data. SETTING: The Hispanic Established Populations for the Epidemiologic Study of the Elderly. PARTICIPANTS: Community-dwelling Mexican American older adults (N = 1455). MEASUREMENTS: We examined insurance status using the Medicare Beneficiary Summary File and estimated the association of sociodemographic and clinical factors with insurance plan switching. RESULTS: Among Mexican American older adults, FFS enrollees were more likely to be born in Mexico, speak Spanish, have lower levels of education, and have more disability than MA enrollees. Older adults with a larger number of limitations of instrumental activities of daily living (odds ratio [OR] =.50; 95% confidence interval [CI] =.26-.98) and more social support (OR =.70; 95% CI =.45-.98) were less likely to switch from FFS to MA compared with older adults with no limitations and less social support. Additionally, older adults living in counties with a greater number of MA plans were more likely to switch from FFS to MA (OR = 2.1; 95% CI = 1.45-3.16), compared with counties with a lower number of MA plans. In counties with a higher number of MA plans, older adults with more social support had lower odds of switching from FFS to MA (OR =.48; 95% CI =.28-.82) compared with older adults with less social support. CONCLUSION: Compared with those enrolled in MA, older Mexican American adults enrolled in Medicare FFS are more socioeconomically disadvantaged and more likely to demonstrate poor health status. Stronger social support and increased physical limitations were strongly associated with less frequent switching from FFS to MA plans. Additionally, increased availability of MA plans at the county level is a significant driver of enrollment in MA plans.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - Jan 1 2019

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Medicare Part C
Fee-for-Service Plans
Health
Social Support
Medicare
Odds Ratio
Confidence Intervals
Independent Living
Insurance Coverage
Vulnerable Populations
Activities of Daily Living

Keywords

  • disability
  • managed care
  • Medicare fee-for-service
  • Mexicans
  • social determinants

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults. / Kumar, Amit; Rivera-Hernandez, Maricruz; Karmarkar, Amol M.; Chou, Lin Na; Kuo, Yong Fang; Baldwin, Julie A.; Panagiotou, Orestis A.; Burke, Robert E.; Ottenbacher, Kenneth J.

In: Journal of the American Geriatrics Society, 01.01.2019.

Research output: Contribution to journalArticle

Kumar, Amit ; Rivera-Hernandez, Maricruz ; Karmarkar, Amol M. ; Chou, Lin Na ; Kuo, Yong Fang ; Baldwin, Julie A. ; Panagiotou, Orestis A. ; Burke, Robert E. ; Ottenbacher, Kenneth J. / Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults. In: Journal of the American Geriatrics Society. 2019.
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title = "Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults",
abstract = "OBJECTIVES: We assessed the characteristics of older Mexican American enrollees in traditional fee-for-service (FFS) and Medicare Advantage (MA) plans and the factors associated with disenrollment from FFS and enrollment in MA plans. DESIGN: Longitudinal study linked with Medicare claims data. SETTING: The Hispanic Established Populations for the Epidemiologic Study of the Elderly. PARTICIPANTS: Community-dwelling Mexican American older adults (N = 1455). MEASUREMENTS: We examined insurance status using the Medicare Beneficiary Summary File and estimated the association of sociodemographic and clinical factors with insurance plan switching. RESULTS: Among Mexican American older adults, FFS enrollees were more likely to be born in Mexico, speak Spanish, have lower levels of education, and have more disability than MA enrollees. Older adults with a larger number of limitations of instrumental activities of daily living (odds ratio [OR] =.50; 95{\%} confidence interval [CI] =.26-.98) and more social support (OR =.70; 95{\%} CI =.45-.98) were less likely to switch from FFS to MA compared with older adults with no limitations and less social support. Additionally, older adults living in counties with a greater number of MA plans were more likely to switch from FFS to MA (OR = 2.1; 95{\%} CI = 1.45-3.16), compared with counties with a lower number of MA plans. In counties with a higher number of MA plans, older adults with more social support had lower odds of switching from FFS to MA (OR =.48; 95{\%} CI =.28-.82) compared with older adults with less social support. CONCLUSION: Compared with those enrolled in MA, older Mexican American adults enrolled in Medicare FFS are more socioeconomically disadvantaged and more likely to demonstrate poor health status. Stronger social support and increased physical limitations were strongly associated with less frequent switching from FFS to MA plans. Additionally, increased availability of MA plans at the county level is a significant driver of enrollment in MA plans.",
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T1 - Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults

AU - Kumar, Amit

AU - Rivera-Hernandez, Maricruz

AU - Karmarkar, Amol M.

AU - Chou, Lin Na

AU - Kuo, Yong Fang

AU - Baldwin, Julie A.

AU - Panagiotou, Orestis A.

AU - Burke, Robert E.

AU - Ottenbacher, Kenneth J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVES: We assessed the characteristics of older Mexican American enrollees in traditional fee-for-service (FFS) and Medicare Advantage (MA) plans and the factors associated with disenrollment from FFS and enrollment in MA plans. DESIGN: Longitudinal study linked with Medicare claims data. SETTING: The Hispanic Established Populations for the Epidemiologic Study of the Elderly. PARTICIPANTS: Community-dwelling Mexican American older adults (N = 1455). MEASUREMENTS: We examined insurance status using the Medicare Beneficiary Summary File and estimated the association of sociodemographic and clinical factors with insurance plan switching. RESULTS: Among Mexican American older adults, FFS enrollees were more likely to be born in Mexico, speak Spanish, have lower levels of education, and have more disability than MA enrollees. Older adults with a larger number of limitations of instrumental activities of daily living (odds ratio [OR] =.50; 95% confidence interval [CI] =.26-.98) and more social support (OR =.70; 95% CI =.45-.98) were less likely to switch from FFS to MA compared with older adults with no limitations and less social support. Additionally, older adults living in counties with a greater number of MA plans were more likely to switch from FFS to MA (OR = 2.1; 95% CI = 1.45-3.16), compared with counties with a lower number of MA plans. In counties with a higher number of MA plans, older adults with more social support had lower odds of switching from FFS to MA (OR =.48; 95% CI =.28-.82) compared with older adults with less social support. CONCLUSION: Compared with those enrolled in MA, older Mexican American adults enrolled in Medicare FFS are more socioeconomically disadvantaged and more likely to demonstrate poor health status. Stronger social support and increased physical limitations were strongly associated with less frequent switching from FFS to MA plans. Additionally, increased availability of MA plans at the county level is a significant driver of enrollment in MA plans.

AB - OBJECTIVES: We assessed the characteristics of older Mexican American enrollees in traditional fee-for-service (FFS) and Medicare Advantage (MA) plans and the factors associated with disenrollment from FFS and enrollment in MA plans. DESIGN: Longitudinal study linked with Medicare claims data. SETTING: The Hispanic Established Populations for the Epidemiologic Study of the Elderly. PARTICIPANTS: Community-dwelling Mexican American older adults (N = 1455). MEASUREMENTS: We examined insurance status using the Medicare Beneficiary Summary File and estimated the association of sociodemographic and clinical factors with insurance plan switching. RESULTS: Among Mexican American older adults, FFS enrollees were more likely to be born in Mexico, speak Spanish, have lower levels of education, and have more disability than MA enrollees. Older adults with a larger number of limitations of instrumental activities of daily living (odds ratio [OR] =.50; 95% confidence interval [CI] =.26-.98) and more social support (OR =.70; 95% CI =.45-.98) were less likely to switch from FFS to MA compared with older adults with no limitations and less social support. Additionally, older adults living in counties with a greater number of MA plans were more likely to switch from FFS to MA (OR = 2.1; 95% CI = 1.45-3.16), compared with counties with a lower number of MA plans. In counties with a higher number of MA plans, older adults with more social support had lower odds of switching from FFS to MA (OR =.48; 95% CI =.28-.82) compared with older adults with less social support. CONCLUSION: Compared with those enrolled in MA, older Mexican American adults enrolled in Medicare FFS are more socioeconomically disadvantaged and more likely to demonstrate poor health status. Stronger social support and increased physical limitations were strongly associated with less frequent switching from FFS to MA plans. Additionally, increased availability of MA plans at the county level is a significant driver of enrollment in MA plans.

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KW - managed care

KW - Medicare fee-for-service

KW - Mexicans

KW - social determinants

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