Barton T. Jones

Summary Medicare Advantage (MA) plans can vary substantially from one another in terms of their coverage design and patient out-of-pocket cost exposure, such as in terms of premiums, co-insurance, co-pays, and deductibles. However, it’s not well understood how different plan design features affect who enrolls in a given MA plan, whether and how certain features may address socioeconomic-related health disparities, or how they impact a plan’s healthcare utilization.

• While Medicare Advantage (MA) now covers over half of Medicare beneficiaries, including a disproportionate share of those facing socioeconomic disadvantage and complex care needs, there is limited understanding of how quality of care under MA compares to Medicare Fee-for-Service (FFS). There is particularly limited understanding on how quality of care differs under MA and FFS for the most disadvantaged or complex populations.

SUMMARY • While Medicare Advantage (MA) now covers over half of Medicare beneficiaries and accounts for over $350 billion in expenditures annually, there is limited understanding of how utilization and efficiency under MA compare to Medicare Fee-for-Service (FFS), especially after adjusting for enrollment differences across the two programs. • Harvard and Inovalon have partnered to answer this critical question definitively using Inovalon’s unique data assets.