Prevalence of Chronic Medical Conditions Among Medicare Advantage and Traditional Medicare Beneficiaries.

Abstract

Background: The federal government spends billions of dollars per year on payments to Medicare Advantage (MA) plans based, in part, on beneficiaries' risk scores. Despite this, little is known about the true burden of chronic medical conditions among MA beneficiaries compared with those in fee-for-service (FFS) Medicare.

Objective: To determine whether the prevalence of chronic medical conditions is higher among MA compared with FFS beneficiaries.

Design: Cross-sectional.

Setting: Population based.

Participants: Adults aged 65 years or older enrolled in MA or FFS Medicare.

Measurements: Using direct physical examination and laboratory data from the National Health and Nutrition Examination Survey (2015 to 2018), we compared the age- and sex-standardized prevalence of obesity, hypertension, hyperlipidemia, diabetes, and chronic kidney disease between MA and FFS beneficiaries.

Results: The unweighted study population included 2446 respondents corresponding to a weighted total of 45 426 711 adults (34.4% MA, 65.6% FFS Medicare). The prevalence of obesity (41.1% vs. 40.6%; standardized difference [SDiff], 0.48 percentage points [pp] [95% CI, -5.2 to 6.2 pp]), hypertension (70.9% vs. 71.0%; SDiff, -0.05 pp [CI, -5.8 to 5.7 pp]), hyperlipidemia (79.4% vs. 82.3%; SDiff, -2.86 pp [CI, -7.0 to 1.3 pp]), and chronic kidney disease (19.2% vs. 22.8%; SDiff, -3.48 pp [CI, -9.2 to 2.3 pp]) was not higher among MA beneficiaries compared with FFS beneficiaries. However, the prevalence of diabetes was higher in MA (33.3% vs. 26.3%; SDiff, 7.00 pp [CI, 3.3 to 10.7 pp]).

Limitation: Differences in the severity of specific medical conditions between groups could not be assessed.

Conclusion: In this nationally representative study from 2015 to 2018, the prevalence of obesity, hypertension, hyperlipidemia, and chronic kidney disease was not higher among MA compared with FFS beneficiaries; however, the prevalence of diabetes was higher among MA beneficiaries.

Primary funding source: National Heart, Lung, and Blood Institute (NHLBI) and American Heart Association (AHA).