Amit Kumar1,2, Maricruz Rivera-Hernandez3, Amol M Karmarkar4, Lin-Na Chou5, Yong-Fang Kuo5, Julie A Baldwin1,2, Orestis A Panagiotou3, Robert E Burke6,7, Kenneth J Ottenbacher5,8. 1. College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona. 2. Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona. 3. Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island. 4. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia. 5. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas. 6. Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania. 7. Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 8. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas.
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. J Am Geriatr Soc 68:313-320, 2020.
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. J Am Geriatr Soc 68:313-320, 2020.
Authors: Anna D Sinaiko; Dennis Ross-Degnan; Stephen B Soumerai; Tracy Lieu; Alison Galbraith Journal: Health Aff (Millwood) Date: 2013-01 Impact factor: 6.301
Authors: J Michael McWilliams; Christopher C Afendulis; Thomas G McGuire; Bruce E Landon Journal: Health Aff (Millwood) Date: 2011-08-18 Impact factor: 6.301