Medicare Advantage Plan Growth in Rural America: Opportunities for Beneficiaries?

Research center:
Lead researcher:
Project funded:
September 2022
Anticipated completion date:
May 2024

This proposed project extends previous RUPRI Center work by exploring differences in the benefits offered by Medicare Advantage (MA) plans as a function of market and population characteristics. We take advantage of improvements in the Centers for Medicare and Medicaid Services (CMS)-provided data about benefits offered by MA plans, such as transportation services, meals, social needs benefit, and home modifications. This project advances research at the critically important nexus of growing Medicare beneficiary enrollment in MA plans and the role of social determinants of health (SDOH) to promote health equity for all beneficiaries. The RUPRI Center routinely downloads monthly MA enrollment reports from CMS. The CMS website also provides detailed information regarding all benefits offered by each MA plan in the MA Benefits Data files. We will use data from 2022 for point-in-time analysis, and data from 2017-2022 for trend analyses. We will use Bureau of the Census data to measure county demographic characteristics. To enrich this project with more detail, we will collect information from public reports of publicly traded MA organizations to profile their SDOH-related activities beyond individual plan benefits.

The first step in analytic methods is a plan-level analysis, assessing the frequency with which benefits addressing SDOH are included in MA plans. We will then examine the distribution of plans with SDOH-related benefits across geographic categories using urban influence codes to classify counties and CMS data defining plan service areas and benefits offered. The next step will assess enrollment in each of the plans offered in counties that include plans offering supplemental SDOH-related benefits. The final piece of analysis will evaluate county population traits across areas with differing availability of supplemental benefits related to SDOH. We will develop a statistical model using regression analysis to test key hypotheses, including whether the number of plans offering SDOH-related benefits is a function of the number of Medicare beneficiaries in the county, the adjacency to metropolitan and micropolitan counties, and the percentage of Medicare beneficiaries below age 80. We will control for other county characteristics such as per capita income and any common trends in MA plans/enrollment.