Medicare Advantage Associated With Reduced Utilization of Discretionary Procedures Across Racial and Ethnic Groups
Key Takeaways:
- For discretionary procedures such as hip replacements, knee replacements, and back surgery, beneficiaries enrolled in Medicare Advantage (MA) had lower rates of utilization compared to those with traditional Medicare (TM).
- White beneficiaries had the greatest gap in utilization compared to Black and Hispanic beneficiaries, indicating reduced utilization among White beneficiaries rather than increased access for Black and Hispanic beneficiaries.
- Utilization of less discretionary cardiac procedures slightly increased among Black and Hispanic beneficiaries, suggesting improvements in care management and access.
Compared to TM, MA is associated with lower health care utilization as beneficiaries have fewer discretionary procedures and less emergency department (ED) visits and hospital admissions.
Because reductions may vary across racial and ethnic groups, researchers analyzed the utilization gap between TM and MA beneficiaries within Hispanic, Black, and White populations.
Study Methods and Outcomes
Investigators used 2021 claims data from the Healthcare Effectiveness Data and Information Set (HEDIS) to assess utilization rates per 1000 beneficiaries for 3 discretionary procedures and 3 cardiac procedures.
The discretionary procedures included hip and knee replacements and back surgery. The cardiac procedures included cardiac catheterizations, percutaneous coronary interventions (PCIs), and coronary artery bypass grafting (CABG). Rates of ED visits and hospitalizations were also observed.
Health Care Utilization Across Racial Groups
The final matched sample included 4 366 556 MA beneficiaries and an equal number of TM beneficiaries. Both the MA and TM cohorts included 3 854 984 (88.3%) White beneficiaries, 2 84 774 (6.5%) Black beneficiaries, and 226 798 (5.2%) Hispanic beneficiaries.
Across all 3 discretionary procedures, MA beneficiaries had lower rates of utilization compared to TM beneficiaries. In addition, the gap between MA and TM utilization was smaller for Black and Hispanic beneficiaries compared to White beneficiaries for all 3 procedures.
MA beneficiaries had lower rates of cardiac catheterizations compared to TM beneficiaries. White beneficiaries had the largest MA-TM gap out of the 3 racial groups.
For PCIs, Black MA beneficiaries had slightly higher rates of utilization compared to TM beneficiaries. White MA beneficiaries had slightly lower rates of PCIs compared to TM beneficiaries.
Rates of CABG were slightly higher among Hispanic and White MA beneficiaries compared to TM beneficiaries, with no significant difference among Black beneficiaries.
MA beneficiaries had lower rates of ED visits and hospitalizations compared to TM beneficiaries. For ED visits, Black beneficiaries had the greatest MA-TM difference. All 3 cohorts had similar MA-TM utilization gaps for hospitalizations.
Implications for Managed Care
White beneficiaries had the greatest reductions in discretionary procedures, while utilization gaps for less discretionary cardiac procedures were similar across racial groups. The authors noted that these reductions may reflect reduced utilization among White beneficiaries rather than increased access among Black and Hispanic beneficiaries.
The reduced utilization of cardiac catheterizations—the most discretionary of the cardiac procedures examined—further supports the association of MA enrollment with lower use of discretionary procedures. Conversely, use of the less discretionary procedures PCIs and CABG slightly increased among minority beneficiaries, suggesting improvements in care and access.
The authors concluded, “Future work should explore drivers of the differential impact of MA by race and ethnicity and identify interventions to promote equitable utilization in the Medicare population.”
Reference
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
