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Today, over half of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, and that number is expected to rise. Keeping people healthy at all life stages requires access to needed health care services and prescription medications.
A study by Assistant Professor Hansoo Ko and Associate Professor Gilbert Gimm in the Department of Health Administration and Policy (HAP) at George Mason’s College of Public Health sought to understand county-level associations between social vulnerability index measures and access to high-quality MA plans.
In their analysis, Ko and Gimm used the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), a measure that documents the degree of unmet social needs in a county. The SVI incorporates socioeconomic factors (e.g. county-level income, employment, education), household makeup, racial/ethnic minority share of a region’s population, and access to housing and transportation in a single composite score (with values from 0 to 1). A greater SVI score indicates a higher level of social vulnerability in a county. For example, lower education attainment or poor access to transportation denote factors that increase social vulnerability.
Researchers analyzed the association between a county’s SVI score and the availability of high-quality MA plans and found that greater county-level social vulnerability was linked to less access to high-quality MA plans.
“People enrolled in Medicare Advantage and living in high SVI counties, where there is limited public transportation for example, had worse access to high-quality MA plans compared to those living in counties with less social vulnerability, in which people, on average, had higher levels of educational attainment, income, and better access to housing and transportation,” said Ko.
According to Ko and Gimm’s analysis, above-average and excellent plans (4+ star ratings) were less available in the southeastern region of the U.S., which had a greater overall proportion of Black/African Americans among its local county populations relative to other regions. The study provides actionable evidence which policymakers can use to monitor social vulnerability at the county level and examine access to high-quality MA plans.
“This study highlights the need for Centers for Medicare and Medicaid Services (CMS) to closely monitor high-quality MA plan availability at the county-level. Although general access to MA plans is adequate at the national level, this study is novel in finding that local disparities in access to high-quality MA plans exist based on a county’s degree of social vulnerability,” said Gimm.
Medicare Advantage, also known as Part C, is a popular alternative to traditional Medicare because it simplifies the enrollment process for Medicare beneficiaries with a “one-stop” bundle of services. Private insurers are responsible for creating a MA plan with a bundle of services and an adequate network of providers in exchange for a fixed payment from CMS.
Ko is an assistant professor, public health physician, and health services researcher specializing in health economics and policy, with a focus on behavioral responses and insurance markets. Gimm is an associate professor with research expertise in disability and aging, program evaluations, health care financing, and community health workers.
The study was co-authored by Ghaida Alsadah, a doctoral student in George Mason’s Health Services Research PhD program.
“Association of Social Vulnerability and Access to Higher Quality Medicare Advantage Plan” was published in December 2024 in the Journal of General Internal Medicine.