Medicare Advantage enrollees' reports of unfair treatment during health care encounters

Abstract

We investigated unfair treatment among 1863 Medicare Advantage (MA) enrollees from 21 MA plans using 2022 survey data (40% response rate) in which respondents indicated whether they were treated unfairly in a health care setting based on any of 10 personal characteristics. We calculated reported unfair treatment rates overall and by enrollee characteristics. Nine percent of respondents reported any unfair treatment, most often based on health condition (6%), disability (3%), or age (2%). Approximately 40% of those reporting any unfair treatment endorsed multiple categories. People who qualified for Medicare via disability reported unfair treatment by disability, age, income, race and ethnicity, sex, sexual orientation, and gender/gender identity more often than those who qualified via age. Enrollees dually eligible for Medicare and Medicaid or eligible for a Low-Income Subsidy (DE/LIS) reported unfair treatment by disability, income, language/accent, race and ethnicity, culture/religion, and sex more often than non-DE/LIS enrollees. Compared with White respondents, racial and ethnic minority respondents more often reported unfair treatment by race and ethnicity, language/accent, culture/religion, and income. Female respondents were more likely than male respondents to report unfair treatment based on age and sex.

Keywords: Medicare Advantage; health equity; survey; unfair treatment.

Figure 1.

Rate of unfair treatment and disability status. Significance levels: *.01 ≤ P < .05, **.001 ≤ P < .01, and ***P < .001 indicate significant difference between groups. n = 1824 respondents.

Figure 2.

Rate of unfair treatment and DE/LIS status. Significance levels: *.01 ≤ P < .05, **.001 ≤ P < .01, and ***P < .001 indicate significant difference between groups. n = 1824 respondents. Abbreviation: DE/LIS, eligible for a Low-Income Subsidy.

Figure 3.

Rate of unfair treatment and respondent race and ethnicity. Significance levels: *.01 ≤ P < .05 and **.001 ≤ P < .01 indicate significant difference between groups. n = 1824 respondents.