Veterans' Age and Disability Status Associated with Choice of Medicare Plans
Medicare-eligible Veterans may choose between care in VA or Medicare (or both), and they also have to choose between obtaining Medicare services in the fee-for-service (FFS) sector or in a Medicare Advantage (MA) plan. Previous studies have shown that many Veterans obtain care from both VA and the Medicare FFS program, but there has been little empirical evaluation of the FFS vs. MA plan choice for Medicare-eligible Veterans. This study sought to assess factors associated with enrollment in an MA vs. FFS plan in 2000-2004 among this population. Using Medicare claims data, VA administrative data, and 2000 Census data, investigators assessed 20,581 age-eligible Veterans (65 and older) and 7,541 disability-eligible Veterans who obtained VA primary care in 2000.
Findings show that age and disability status were both significantly associated with choice of MA vs. FFS plan. For example, age-eligible Veterans were more likely to be enrolled in an MA plan if aged 75 or older, female, able to receive free VA care, or not enrolled in Medicaid, while disability-eligible Veterans were more likely to be enrolled if they were married or elderly. Minority Veterans and Veterans with lower disease risk scores (better average health) were more likely to be enrolled in an MA plan than white Veterans or Veterans with higher risk scores. Overall, Veterans living in zip codes with greater population density and higher per capita income were also more likely to enroll in an MA plan. The authors suggest that future studies examine the Medicare health plan choice of disabled Veterans, particularly OEF/OIF Veterans who begin to qualify for Medicare, to better understand the possible impact of MA enrollment on continuity, duplication, cost, and quality of care.
Maciejewski M, Birken S, Perkins M, Burgess J, Sharp N, and Liu C. Medicare Managed Care Enrollment by Disability-Eligible and Age-Eligible Veterans. Medical Care November 2009;47(11):1180-1185.
This study was funded by HSR&D. Dr. Maciejewski is part of HSR&D's Center for Health Services Research in Primary Care in Durham, NC, Dr. Burgess is part of HSR&D's Center for Organization, Leadership, and Management Research in Boston, and Drs. Sharp and Liu are part of HSR&D's Northwest Center for Outcomes Research in Older Adults in Seattle.