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In recent years, the share of Medicare beneficiaries enrolled in Medicare Advantage, the private health plan alternative to the traditional Medicare program, has grown substantially. In 2021, 42% of all Medicare beneficiaries were enrolled in Medicare Advantage, up from 24% a decade earlier, with higher enrollment among some subgroups of beneficiaries than others. In 2018, half of all Black and Hispanic beneficiaries were enrolled in a Medicare Advantage plan, compared to 36% of White beneficiaries.

Given these shifts in enrollment and broader concerns about health inequities among Medicare beneficiaries, this analysis builds on our prior work examining rates of health care cost-related problems among Medicare beneficiaries, taking a closer look at cost-related problems among beneficiaries in traditional Medicare, including those with and without supplemental coverage, compared to those in Medicare Advantage, with a focus on equity.

Our analysis uses data from the 2018 Medicare Current Beneficiary Survey (MCBS) to examine the share of non-institutionalized Medicare beneficiaries reporting at least one of the following: trouble getting care due to cost or money, delay in care due to cost, or problems paying medical bills. All estimates reported in the text are statistically significant in bivariate (i.e., tabulations) and multivariate (i.e., based on a regression) analyses, except where noted. The multivariate analysis controls for income, race and ethnicity, and health status (see Methods). Due to sample size and data collection limitations, we were unable to analyze results by race and ethnicity for Asian adults, American Indian and Alaska Native adults, and Native Hawaiian and Other Pacific Islander adults, as well as certain subgroups of Hispanic adults.

Key findings include:

  • Overall, about one in six Medicare beneficiaries (17%) reported a cost-related problem in 2018, with a somewhat lower rate among traditional Medicare beneficiaries (15%) than Medicare Advantage enrollees (19%), attributable to a lower rate of cost-related problems among the majority of traditional Medicare beneficiaries with supplemental coverage (12%) . The rate of cost-related problems is highest (30%) among traditional Medicare beneficiaries without supplemental coverage, who account for about 10 percent of the Medicare population.
  • A smaller share of Black beneficiaries in traditional Medicare (24%) than in Medicare Advantage (32%) reported cost-related problems. Rates of cost-related problems were lower among Black beneficiaries in traditional Medicare with Medicaid and other forms of supplemental insurance (20%).
  • One in five Hispanic beneficiaries overall reported a cost related problem (21%) and the share was similar among those in traditional Medicare with supplemental coverage (18%) and Medicare Advantage (22%).
  • The share of Black Medicare beneficiaries reporting cost-related problems was higher than among White beneficiaries in both traditional Medicare and Medicare Advantage. Additionally, the difference in the share of Black beneficiaries reporting cost-related problems in Medicare Advantage compared to traditional Medicare with supplemental coverage was larger than for White beneficiaries.
  • Half of Black Medicare Advantage enrollees in fair or poor self-assessed health reported cost-related problems, compared to one-third of Black beneficiaries in traditional Medicare overall and just over one-fourth of Black beneficiaries in traditional Medicare with supplemental coverage.


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