{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:23:05Z","timestamp":1788967385312,"version":"build-2803163510"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Medicare Advantage (MA) plans use health care utilization management and other approaches that may be associated with different utilization patterns among beneficiaries from different racial and ethnic groups compared with traditional Medicare (TM).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To measure the MA-TM utilization gap across racial and ethnic groups.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study included Medicare beneficiaries 65 years or older continuously enrolled in MA and a 20% random sample of TM beneficiaries during 2021. TM beneficiaries were matched to MA beneficiaries by geographic location, age, and sex separately for Black, Hispanic, and White beneficiaries. Data analysis was conducted between August 2025 and January 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n MA vs TM enrollment.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n Utilization rates per 1000 beneficiaries for 3 discretionary procedures (hip, knee replacement, and back surgery), 3 less discretionary cardiac procedures (cardiac catheterizations, percutaneous coronary interventions, and coronary artery bypass grafting), and 2 overall measures (emergency department visits and hospitalizations). MA utilization was measured using Healthcare Effectiveness Data and Information Set data; TM utilization measures were created following the exact same specifications.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The final matched samples included 4 366 556 MA beneficiaries (2 442 688 [56.0%] female; 1 254 260 [28.7%] aged 71-75 years; 2 84 774 [6.5%] Black, 226 798 [5.2%] Hispanic, and 3 854 984 [88.3%] White) and 4 366 556 TM beneficiaries (2 442 688 [56.0%] female; 1 254 260 [28.7%] aged 71-75 years; 284 774 [6.5%] Black, 226 798 [5.2%] Hispanic, and 3 854 984 [88.3%] White). The MA-TM gap was largest for White beneficiaries for discretionary procedures. For example, there were 2.51 fewer (95% CI, \u22122.52 to \u22122.49) knee replacements per 1000 beneficiaries for White beneficiaries in MA vs TM, 1.26 fewer (95% CI, \u22121.32 to \u22121.21) for Black compared with White beneficiaries (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and 0.60 fewer (95% CI, \u22120.66 to \u22120.55) for Hispanic compared with White beneficiaries (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Among Hispanic and White beneficiaries, rates of coronary artery bypass grafting were marginally higher in MA vs TM (1.84 [95% CI, 1.67 to 2.02] vs 1.41 [95% CI, 1.25 to 1.56] per 1000 beneficiaries [\n P<\/jats:italic>\n &amp;lt; .001]; 2.22 [95% CI, 2.17 to 2.26] vs 2.12 [95% CI, 2.05 to 2.20] per 1000 beneficiaries [\n P<\/jats:italic>\n = .004], respectively) but not significantly different among Black beneficiaries in MA vs TM (1.37 [95% CI, 1.23 to 1.52] vs 1.45 [95% CI, 0.69 to 2.20];\n P<\/jats:italic>\n = .44). Compared with White beneficiaries, the MA-TM gap was significantly different but of similar magnitude for Black (0.09 [95% CI, 0.08 to 0.10] vs \u22120.07 [95% CI, \u22120.15 to 0.00];\n P<\/jats:italic>\n &amp;lt; .001) and Hispanic (0.09 [95% CI, 0.08 to 0.10] vs 0.44 [95% CI, \u22120.40 to 0.47];\n P<\/jats:italic>\n = .007) beneficiaries. Hospitalizations showed similar MA-TM gaps across race and ethnicity. Emergency department visit rates were lower in the MA group, with the greatest difference among Black beneficiaries.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of MA and TM beneficiaries, exposure to MA was associated with a narrowing of utilization gaps for discretionary procedures with similar impacts on utilization across racial and ethnic groups for less discretionary procedures and overall utilization. Observed reductions in disparities in utilization possibly reflect reductions in discretionary use of procedures among White beneficiaries rather than increased access for Black and Hispanic beneficiaries.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.32953","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:00:46Z","timestamp":1788966046000},"page":"e2632953","source":"Crossref","is-referenced-by-count":0,"title":["Health Care Utilization and Equity in Medicare Advantage Compared With Traditional Medicare"],"prefix":"10.1001","volume":"9","author":[{"given":"Lucy B.","family":"Schulson","sequence":"first","affiliation":[{"name":"Section of General Internal Medicine, Boston Medical Center\/Chobanian and Avedisian School of Medicine at Boston University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Hatfield","sequence":"additional","affiliation":[{"name":"Department of Statistics and Data Science, NORC at the University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy S.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Z.","family":"Ayanian","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"Division of General Medicine, University of Michigan Medical School, Ann Arbor"},{"name":"Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor"},{"name":"Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce E.","family":"Landon","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts"},{"name":"Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"14","key":"zoi260897r1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009014","article-title":"Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among Medicare beneficiaries, 1999-2014.","volume":"7","author":"Angraal","year":"2018","journal-title":"J Am Heart Assoc"},{"issue":"24","key":"zoi260897r2","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1093\/jnci\/djt333","article-title":"Racial and ethnic differences in use of mammography between Medicare Advantage and traditional Medicare.","volume":"105","author":"Ayanian","year":"2013","journal-title":"J Natl Cancer Inst"},{"key":"zoi260897r3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-074908","article-title":"Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.","author":"Ganguli","journal-title":"BMJ"},{"issue":"12","key":"zoi260897r4","doi-asserted-by":"publisher","first-page":"2697","DOI":"10.1007\/s11606-019-05426-4","article-title":"Racial and ethnic differences in healthcare utilization among Medicare fee-for-service enrollees.","volume":"34","author":"Kim","year":"2019","journal-title":"J Gen Intern Med"},{"issue":"3","key":"zoi260897r5","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/SLA.0000000000002695","article-title":"Disparities in rates of surgical intervention among racial and ethnic minorities in Medicare accountable care organizations.","volume":"269","author":"Schoenfeld","year":"2019","journal-title":"Ann Surg"},{"issue":"24","key":"zoi260897r6","doi-asserted-by":"publisher","first-page":"2120","DOI":"10.2106\/JBJS.20.00246","article-title":"Geographic variation and disparities in total joint replacement use for Medicare beneficiaries: 2009 to 2017.","volume":"102","author":"Thirukumaran","year":"2020","journal-title":"J Bone Joint Surg Am"},{"issue":"7","key":"zoi260897r8","doi-asserted-by":"publisher","first-page":"E303","DOI":"10.1097\/BSD.0000000000001576","article-title":"Does Medicare insurance mitigate racial\/ethnic disparities in access to lumbar spinal surgery when compared to commercial insurance?","volume":"37","author":"Herrera","year":"2024","journal-title":"Clin Spine Surg"},{"issue":"1","key":"zoi260897r9","doi-asserted-by":"publisher","first-page":"13538","DOI":"10.1038\/s41598-020-70470-8","article-title":"Examining multimorbidity differences across racial groups: a network analysis of electronic medical records.","volume":"10","author":"Kalgotra","year":"2020","journal-title":"Sci Rep"},{"issue":"9","key":"zoi260897r10","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1007\/s11606-010-1399-5","article-title":"The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting.","volume":"25","author":"Hausmann","year":"2010","journal-title":"J Gen Intern Med"},{"issue":"7","key":"zoi260897r11","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1002\/acr.21925","article-title":"Race, sex, and total knee replacement consideration: role of social support.","volume":"65","author":"Vina","year":"2013","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"zoi260897r12","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1146\/annurev-publhealth-040218-043750","article-title":"Racism and health: evidence and needed research.","volume":"40","author":"Williams","year":"2019","journal-title":"Annu Rev Public Health"},{"issue":"4","key":"zoi260897r13","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1377\/hlthaff.2022.00891","article-title":"Differences in use of services and quality of care in Medicare Advantage and traditional Medicare, 2010 And 2017.","volume":"42","author":"Landon","year":"2023","journal-title":"Health Aff (Millwood)"},{"issue":"2","key":"zoi260897r14","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1162\/AJHE_a_00074","article-title":"The effect of Medicare Advantage on hospital admissions and mortality.","volume":"3","author":"Afendulis","year":"2017","journal-title":"Am J Health Econ"},{"issue":"9","key":"zoi260897r15","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxaf177","article-title":"Zero-premium Medicare Advantage plans: trends in areas with socioeconomic vulnerability and health needs.","volume":"3","author":"Jiang","year":"2025","journal-title":"Health Aff Sch"},{"issue":"1-2","key":"zoi260897r17","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s10742-010-0060-4","article-title":"Identifying types of nursing facility stays using Medicare claims data: an algorithm and validation.","volume":"10","author":"Yun","year":"2010","journal-title":"Health Serv Outcomes Res Methodol"},{"issue":"9","key":"zoi260897r18","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.2935","article-title":"Comparison of low-value services among Medicare Advantage and traditional Medicare beneficiaries.","volume":"3","author":"Boudreau","year":"2022","journal-title":"JAMA Health Forum"},{"key":"zoi260897r19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-077797","article-title":"Comparison of prior authorization across insurers: cross sectional evidence from Medicare Advantage.","volume":"384","author":"Gupta","year":"2024","journal-title":"BMJ"},{"issue":"7","key":"zoi260897r20","doi-asserted-by":"publisher","first-page":"1814","DOI":"10.1007\/s11606-021-06955-7","article-title":"Ambulatory care sensitive condition admission rates in younger and older traditional Medicare and Medicare Advantage populations, 2011-2019.","volume":"37","author":"Weeks","year":"2022","journal-title":"J Gen Intern Med"},{"issue":"1","key":"zoi260897r21","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1177\/1062860617702240","article-title":"Inappropriate utilization in fee-for-service Medicare and Medicare Advantage plans.","volume":"33","author":"Parashuram","year":"2018","journal-title":"Am J Med Qual"},{"issue":"7","key":"zoi260897r22","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1001\/jama.2021.10413","article-title":"Association of race and ethnicity and Medicare program type with ambulatory care access and quality measures.","volume":"326","author":"Johnston","year":"2021","journal-title":"JAMA"},{"issue":"17","key":"zoi260897r24","doi-asserted-by":"publisher","first-page":"381","DOI":"10.15585\/mmwr.mm6817a2","article-title":"State-specific severe joint pain and physical inactivity among adults with arthritis - United States, 2017.","volume":"68","author":"Guglielmo","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"10077","key":"zoi260897r25","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(17)30569-X","article-title":"Structural racism and health inequities in the USA: evidence and interventions.","volume":"389","author":"Bailey","year":"2017","journal-title":"Lancet"},{"issue":"6","key":"zoi260897r26","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.0793","article-title":"Association of Medicare Advantage Star ratings with racial, ethnic, and socioeconomic disparities in quality of care.","volume":"2","author":"Meyers","year":"2021","journal-title":"JAMA Health Forum"},{"issue":"70","key":"zoi260897r27","article-title":"Contract year 2024 policy and technical changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly.","volume":"88","author":"Centers for Medicare & Medicaid Services, Dept of Health and Human Services","year":"2023","journal-title":"Fed Regist"},{"issue":"2","key":"zoi260897r29","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1111\/1475-6773.12229","article-title":"Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: results from a primary care network.","volume":"50","author":"Berkowitz","year":"2015","journal-title":"Health Serv Res"},{"key":"zoi260897r7","unstructured":"Ochieng? N, Cubanski? J, Neuman? T, Artiga? S, Damico? A. Racial and ethnic health inequities and Medicare. KFF. Published online February 16, 2021. Accessed August 20, 2026. https:\/\/www.kff.org\/report-section\/racial-and-ethnic-health-inequities-and-medicare-access-to-care-and-service-utilization\/"},{"key":"zoi260897r16","unstructured":"Bonito? A, Bann? C, Eicheldinger? C, Carpenter? L. Creation of new race-ethnicity codes and socioeconomic status (SES) indicators for Medicare beneficiaries: final report, sub-task 2. Published online January 2008. Accessed July 23, 2026. https:\/\/archive.ahrq.gov\/research\/findings\/final-reports\/medicareindicators\/medicareindicators.pdf"},{"key":"zoi260897r23","unstructured":"Barlow? J. We Used Your Insights to Update Our Graphic on Equity. Robert Wood Johnson Foundation; November 21, 2022. Accessed August 20, 2026. https:\/\/www.rwjf.org\/en\/insights\/blog\/2022\/11\/we-used-your-insights-to-update-our-graphic-on-equity.html"},{"key":"zoi260897r28","unstructured":"Centers for Medicare & Medicaid Services. CMS proposes new policies to strengthen quality, access and competition in Medicare Advantage and Part D. Published online November 25, 2025. Accessed August 20, 2026. https:\/\/www.cms.gov\/newsroom\/press-releases\/cms-proposes-new-policies-strengthen-quality-access-competition-medicare-advantage-part-d"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2853852\/schulson_2026_oi_260897_1788273406.6428.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:00:49Z","timestamp":1788966049000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2853852"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":29,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.32953","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}