Medicare Advantage Utilization Gaps Varied by Race

A retrospective cohort study published in JAMA Network Open found that Medicare Advantage (MA) enrollment was associated with lower use of the assessed discretionary procedures and lower observed-to-expected emergency department visit and hospitalization ratios than traditional Medicare (TM) across Black, Hispanic, and White beneficiaries. Differences in discretionary procedure use were largest among White beneficiaries.

Investigators analyzed 2021 data from beneficiaries aged 65 years or older continuously enrolled in MA and a 20% random TM sample. Within each racial and ethnic group, investigators matched TM beneficiaries to MA beneficiaries by age, sex, and geography. The matched cohorts included 4,366,556 beneficiaries each. Outcomes included 3 orthopedic procedures characterized as discretionary, 3 cardiac procedures characterized as less discretionary, emergency department visits, and hospitalizations.

Knee replacement rates per 1000 beneficiaries in MA vs TM were 7.03 vs 8.30 among Black beneficiaries, 7.47 vs 8.07 among Hispanic beneficiaries, and 10.44 vs 12.95 among White beneficiaries. The MA-TM differences were smaller for Black and Hispanic beneficiaries than for White beneficiaries. Hip replacement and back surgery showed similar patterns.

Observed-to-expected emergency department visit ratios were also lower in MA than TM: 1.05 vs 2.12 among Black beneficiaries, 0.97 vs 1.75 among Hispanic beneficiaries, and 0.86 vs 1.65 among White beneficiaries. Unlike the procedure findings, the MA-TM gap in emergency department visits was significantly larger for Black beneficiaries than White beneficiaries (-1.06 vs -0.78 in the O/E ratio; P < 0.001), a pattern not seen for Hispanic beneficiaries; the investigators said this may reflect improved access to primary care for Black beneficiaries in MA. Hospitalization ratios were lower in MA, but racial and ethnic differences in the MA-TM gap were small. Results were consistent in analyses stratified by health maintenance organization and preferred provider organization plan type.

Investigators said the apparent narrowing of utilization gaps may reflect reduced discretionary procedure use among White beneficiaries rather than greater access for Black and Hispanic beneficiaries. Limitations included possible residual confounding, reliance on a single year of 2021 data, possible COVID-19 pandemic effects, lack of clinical detail to assess care appropriateness, and focus on orthopedics and cardiology.

Source: Schulson LB, Hatfield L, Chen A, et al. Health care utilization and equity in Medicare Advantage compared with traditional Medicare. JAMA Netw Open. 2026;9(9):e2632953. doi:10.1001/jamanetworkopen.2026.32953