Among Medicare Part D beneficiaries, self-reported metrics related to health status differ by certain demographic characteristics. Understanding these differences may help key entities in the individual Part D market identify which demographic groups may be more likely to benefit from targeted intervention and subsequently organize more directed initiatives to serve these populations.
Background
This article examines key metrics related to health status from the 2019 Medicare Current Beneficiary Survey (MCBS) produced by the Centers for Medicare and Medicaid Services (CMS)1 and highlights observed differences by race/ethnicity, income, and education level for beneficiaries enrolled in an individual Medicare Part D plan. We summarize data and provide discussion around the following topics:
- Beneficiaries’ perceptions of their general health status compared to others of the same age
- Self-reported functional limitations
- Self-reported diabetes/high blood sugar prevalence
Our analysis includes beneficiaries enrolled in a Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug (MAPD) plan. For more information on these plan types and a detailed summary of beneficiary demographics, please refer to our prior article (findings do not differ between 2018 and 2019).
Results
General health status
Just under one out of every two Part D beneficiaries reported that they believe their health to be excellent or very good compared to others of the same age. This distribution, however, differs by race/ethnicity, income, and education.
Race/ethnicity
Approximately half of non-Hispanic white beneficiaries reported their general health compared to others of the same age to be excellent or very good (Figure 1). In comparison, less than one in three (30.2%) non-Hispanic Black beneficiaries reported their general health compared to others of the same age to be excellent or very good. Hispanic beneficiaries report a similar pattern.
Figure 1: Self-reported general health compared to others the same age among Medicare Part D beneficiaries overall and by race/ethnicity group
The MCBS provides four options for reporting race/ethnicity, which we use throughout this report: Non-Hispanic white, Non-Hispanic Black, Hispanic, and Other. Our analysis shows that more than seven out of ten Part D beneficiaries are non-Hispanic white.
Income and education
Part D beneficiaries that report higher incomes—more than 200% of the federal poverty level (FPL)—are more likely to report their general health to be excellent or very good compared to others of the same age relative to those with lower incomes (59.0% for higher incomes; 36.0% for middle incomes; 26.3% for lower incomes).
Part D beneficiaries who report more than high school education are more likely to report their general health to be excellent or very good compared to others of the same age relative to those with high school education or less (55.4% for more than high school; 41.9% for high school; 30.9% for less than high school).
Functional limitations
As another indicator of the health status of Part D beneficiaries, we analyzed whether Part D beneficiaries report having functional limitations related to activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs). ADLs are the physical skills required to manage one’s essential needs (e.g., eating, grooming, ambulating). IADLs are more complex activities associated with the ability to live independently (e.g., food preparation, managing finances). Our analysis shows that over half of Part D beneficiaries reported having no functional limitations (Figure 2).
Figure 2: Self-reported functional limitations among Medicare Part D beneficiaries
Race/ethnicity, income, and education
We observe the following from our analysis:
- Non-Hispanic Black (55.3%) and Hispanic (50.1%) beneficiaries are more likely to report having functional limitations relative to non-Hispanic white (39.6%) beneficiaries and beneficiaries of other race/ethnicity (47.2%; Figure 3).
- Part D beneficiaries with income less than 100% of the FPL are more than twice as likely to report having functional limitations relative to those with incomes more than 200% of the FPL (63.1% versus 30.3%; Figure 4).
- Part D beneficiaries with less than a high school education are 60% more likely to report having functional limitations relative to those with more than high school education (56.4% versus 35.3%; Figure 5).
Figure 3: Functional limitations reported by Medicare Part D beneficiaries by race/ethnicity group
| FUNCTIONAL LIMITATIONS | NON-HISPANIC BLACK |
HISPANIC | OTHER | NON-HISPANIC WHITE |
|---|---|---|---|---|
| None | 44.7% | 49.9% | 52.8% | 60.4% |
| IADL limitations only | 17.8% | 15.9% | 14.7% | 13.5% |
| 1 to 2 ADL limitations | 22.4% | 17.1% | 17.2% | 17.4% |
| 3 to 4 ADL limitations | 9.6% | 9.6% | 8.7% | 5.4% |
| 5 to 6 ADL limitations | 5.5% | 7.5% | 6.6% | 3.3% |
Figure 4: Functional limitations reported by Medicare Part D beneficiaries by income poverty ratio group
| FUNCTIONAL LIMITATIONS | ≤ 100% OF THE FPL |
> 100% AND ≤
200% OF THE FPL |
>200% OF THE FPL |
|---|---|---|---|
| None | 36.9% | 44.7% | 69.7% |
| IADL limitations only | 21.3% | 16.6% | 10.9% |
| 1 to 2 ADL limitations | 23.5% | 24.0% | 13.2% |
| 3 to 4 ADL limitations | 10.2% | 9.2% | 4.0% |
| 5 to 6 ADL limitations | 8.1% | 5.5% | 2.2% |
Figure 5: Functional limitations reported by Medicare Part D beneficiaries by highest grade completed
| FUNCTIONAL LIMITATIONS | LESS THAN HIGH SCHOOL |
HIGH SCHOOL OR EQUIVALENT |
MORE THAN HIGH SCHOOL |
|---|---|---|---|
| None | 43.6% | 52.3% | 64.7% |
| IADL limitations only | 17.4% | 16.0% | 12.0% |
| 1 to 2 ADL limitations | 23.1% | 19.1% | 15.6% |
| 3 to 4 ADL limitations | 9.0% | 7.9% | 4.8% |
| 5 to 6 ADL limitations | 6.9% | 4.7% | 2.9% |
Diabetes/high blood sugar prevalence
Finally, we analyzed the prevalence of diabetes. Our analysis shows that approximately one in three (34.5%) Part D beneficiaries reported having diabetes/high blood sugar at some point in their lifetimes. Compared to non-Hispanic white beneficiaries, more non-Hispanic Black and Hispanic beneficiaries reported having diabetes/high blood sugar (Figure 6).
Figure 6: Diabetes/high blood sugar (ever) reported by Medicare Part D beneficiaries by race/ethnicity group
| DIABETES/HIGH BLOOD SUGAR (EVER) | NON-HISPANIC BLACK | HISPANIC | OTHER | NON-HISPANIC WHITE |
|---|---|---|---|---|
| Yes | 47.4% | 46.8% | 46.6% | 29.9% |
| No | 52.6% | 53.2% | 53.4% | 70.1% |
We observed less substantial differences in reported diabetes/high blood sugar for Part D beneficiaries for other demographic factors:
- Among Part D beneficiaries with incomes less than 100% of the FPL, 39.7% reported having diabetes/high blood sugar, while 30.5% of those with incomes over 200% of the FPL reported having diabetes/high blood sugar.
- Among Part D beneficiaries with less than a high school education, 41.4% reported having diabetes/high blood sugar, while 32.2% of those with more than a high school education reported having diabetes/high blood sugar.
Methodology
We relied on publicly available data for this analysis. The MCBS is produced annually by CMS with three separate survey rounds. We used the Fall 2019 Public Use Files (PUFs), which included 14,167 responses from community-dwelling Medicare beneficiaries. We limited our analysis to responses from beneficiaries who were enrolled in a PDP or MAPD plan throughout the year. We defined PDP status based on having annual Part D coverage and either (1) no MA coverage for the year, or (2) never enrolling in MA during the year. We defined MAPD status based on having MA annual enrollment and having annual Part D enrollment. Respondents not meeting these criteria were not included in this analysis (N = 2,866). We reported weighted frequencies to account for the survey sampling design such that data distributions are nationally representative.
This data is self-reported by survey respondents and reflects the biases used in the survey data generation process. Such data must only be used for appropriate situations and may not be appropriate for specific applications. The information presented in this document is for general knowledge of the Part D population and is not to be used for other purposes.
The variables we summarized from the MCBS PUF include:
- Annual Part D coverage: ADM_PARTD
- MA coverage during year: ADM_MA_FLAG_YR
- Annual MA enrollment: INS_D_MADV
- MA plan covers Part D: INS_MADVRXHT
- Diabetes: HLT_OCBETES
- Income poverty ratio: DEM_IPR_IND
- Education: DEM_EDU
- Race/ethnicity group: DEM_RACE
- General health compared to others of the same age: HLT_GENHELTH
- Body mass index (BMI) categories (kg/m^2): HLT_BMI_CAT
- Difficulty walking one-quarter of a mile: HLT_DIFWALK
- Functional limitations: IADLs and ADLs: HLT_FUNC_LIM
Additional directives
The variables summarized here were selected as indicators of Part D beneficiaries’ health status. Understanding beneficiaries’ perspectives can help key stakeholders in the Part D program (e.g., plan sponsors, legislators, pharmaceutical manufacturers) provide services that maximize value for given demographic populations. From this data, we observe differences by certain demographic characteristics in self-reported health status relative to others of the same age, functional limitations, and diabetes/high blood sugar prevalence. There is opportunity for more directed follow-up analyses focusing on specific self-reported health conditions that may vary by demographic. This area of research could help stakeholders develop more targeted initiatives for Part D beneficiaries.
1 CMS (2021). 2019 Medicare Current Beneficiary Survey (MCBS) Public Use File [2019MCBSPUFUserGuide.PDF, MCBSPUF19.txt, MCBSPUF_2019_1_Fall.txt, puf2019_1_fall.csv, puf2019_1_fall.xpt]. Retrieved July 5, 2022, from https://www.cms.gov/research-statistics-data-and-systems/downloadable-public-use-files/mcbs-public-use-file.