Changes in mortality among Medicare Advantage and traditional Medicare beneficiaries associated with the COVID-19 pandemic

The problem:

Medicare beneficiaries, who are typically 65 or older with more complex medical needs, experienced a disproportionate number of deaths during the COVID-19 pandemic—both from direct and indirect causes. However, little is known about whether the COVID-19 pandemic differentially affected the risk of death among Medicare beneficiaries enrolled in traditional Medicare versus those enrolled in Medicare Advantage (MA), a plan that is growing in popularity particularly among minorities and those in poverty. Given that MA plans receive capitated payments to care for beneficiaries, they have more flexibility to offer benefits and services beyond those offered by traditional Medicare, such as dental insurance, prescription drugs, and transportation to medical appointments. These benefits may have better protected enrollees from the devastation of the COVID-19 pandemic.

The approach:

The team aims to:

1. determine if there are similar increases in mortality between traditional Medicare and Medicare Advantage plans,

2. determine if any increases in mortality differ by rurality or social vulnerability, and

3. examine the impact of coverage differences in the context of ongoing care disruptions during the latter part of pandemic.

They used the Virtual Research Data Center to examine utilization between January 2018 and December 2019 (pre-COVID) and January 2021 to December 2022 (later COVID). Then they calculated mortality rates at the county level by month and compared between the two Medicare plans and geographic makeup, adjusted for demographic differences between counties using a lognormal Poisson model.

The findings:

The sample included 510,550,103 beneficiary-months in Medicare Advantage and 830,852,385 beneficiary-months in traditional Medicare. Individuals from Medicare Advantage were more likely to be female, Black, and Hispanic, but less likely to be dually enrolled in Medicaid or live in a rural or micropolitan area.

In the pre-pandemic period, the risk of death among Medicare Advantage beneficiaries was lower than those in traditional Medicare. During the pandemic, risk of death increased for both Medicare Advantage and traditional Medicare beneficiaries, with greater increases among those enrolled in Medicare Advantage. Overall, all groups had a 15 to 20 percent relative increase in mortality rates from pre- to later COVID.

These increases in mortality rates for both traditional Medicare and Medicare Advantage followed COVID-19’s peaks as well as typical increases in mortality rates in the winter caused by peaks in influenza. When stratifying for rurality, the analysis indicates that traditional Medicare and Medicare Advantage rural and micropolitan subgroups had higher increases in mortality throughout most of the study period—including prepandemic and later COVID—than the urban subgroup. However, during the early pandemic, roughly March-May of 2020, the urban group experienced higher rates of mortality.

These findings suggest that despite Medicare Advantage plans having more benefits and services for their enrollees, beneficiaries were not more protected from risk of death compared to their traditional Medicare peers.