More than 40% of Medicare beneficiaries now choose Medicare Advantage (MA) private plans. As the number of MA beneficiaries grows—particularly among Black and Latinx communities—it is important to understand how enrollment in MA affects racial disparities in quality of care. A new Medical Care study by LDI Fellow Norma Coe and colleagues finds cause for concern, revealing racial disparities in avoidable hospitalizations that are even greater than in traditional Medicare.

For “ambulatory-care sensitive conditions” (ACSCs) such as diabetes, asthma, urinary tract infections, and heart failure, early interventions and good primary care can prevent the need for hospitalization. In traditional Medicare, disparities in ACSC hospitalization among Black and white beneficiaries has been well-documented. Despite the hope that MA plans could close this gap, Coe and colleagues find even greater disparities between Black and white MA beneficiaries.

Using 2015-2016 national inpatient Medicare data, the authors found that Black beneficiaries had higher adjusted rates of avoidable hospitalization than white beneficiaries in both traditional Medicare and MA, with greater disparities in MA. As shown in Table 1, white beneficiaries had similar rates of avoidable hospitalizations in traditional Medicare and MA; however, Black beneficiaries had higher rates of avoidable hospitalizations in MA than traditional Medicare.  As a result, the racial difference was wider in MA than in traditional Medicare.

Traditional Medicare (TM) Medicare Advantage (MA)
Racial Difference45.659.0

Table 1. Adjusted Racial Differences in Hospitalizations for Ambulatory Care Sensitive Conditions Between TM and MA (% per 10,000 beneficiaries). Adapted from Park et al., Medical Care, 2021.

These national data cannot tell us the extent to which racial disparities are due to unequal treatment by hospitals or providers, or attributable to regional difference in access and quality of treatment. This matters because policy prescriptions may need to be location-specific. But when the authors examined rates of ACSC hospitalizations by hospital referral region, they found that racial disparities among MA recipients persisted across nearly all regions, compared to 54% of regions for those in traditional Medicare.

These findings align with previous research showing that, compared to white MA beneficiaries, Black beneficiaries have less access to primary care and are more likely to enroll in low-quality MA plans. This study provides further evidence of racial disparities in access to high-quality primary care, especially in MA.  Narrowing this gap remains a policy priority and ethical imperative.

The study, Racial Disparities in Avoidable Hospitalizations in Traditional Medicare and Medicare Advantage, was published in Medical Care in August 2021. Authors include Sungchul Park, Paul Fishman, and Norma B. Coe.


Liz Donhauser

Elizabeth Donhauser

Policy Coordinator, Leonard Davis Institute of Health Economics

Janet Weiner

Janet Weiner, PhD, MPH

Co-Director for Health Policy, Leonard Davis Institute of Health Economics

More on Health Equity