Patient-Reported Characteristics Across Dual-Eligible Medicare Advantage Plan Types

Importance: A growing proportion of full-benefit dual-eligible Medicare and Medicaid beneficiaries (ie, individuals receiving Medicare and full Medicaid) are enrolled in Medicare Advantage (MA). MA plans vary in capacity and incentives to coordinate Medicare and Medicaid services, but little is known about the characteristics of dual-eligible beneficiaries across plan types. Objectives: To compare the health and demographic characteristics of full-benefit dual-eligible beneficiaries across 4 MA plan types varying in Medicare-Medicaid service coordination and spending requirements. Design, Setting, and Participants: This cross-sectional study analyzed Medicare Health Outcomes Survey (HOS) data from 2017 to 2019, including 147923 full-benefit dual-eligible beneficiaries (mean response rate, 29%) enrolled in MA in January of the survey year. Analyses were conducted from January 2024 to January 2025. Exposure: Enrollment in different MA plans. Main Measures and Outcomes: This study examined beneficiary characteristics and enrollment across 4 MA plan types: standard MA plans serving dual and nondual beneficiaries; coordination-only dual-eligible Special Needs Plans (D-SNPs) with Medicaid contracts and care coordination requirements serving dual-eligibles; D-SNP look-alikes, marketed to dual-eligible beneficiaries but exempt from D-SNP regulations; and fully integrated D-SNPs (FIDE-SNPs), which integrate Medicare and Medicaid services and spending. Beneficiary characteristics included demographics, self-reported comorbidities, functional status, living arrangements, and community-level factors, like the Area Deprivation Index (ADI). Results: The study included 147923 dual-eligible beneficiaries with full Medicaid (mean (SD) age, 67.7 [13.9] years; 93803 [63.4%] female), distributed across FIDE-SNPs (25755 beneficiaries), coordination-only D-SNPs (65220 beneficiaries), D-SNP look-alike plans (5193 beneficiaries), and standard MA plans (51755 beneficiaries). Overall, 14215 respondents (9.6%) were aged 85 years or older, and 9618 respondents (6.5%) lived with a caregiver. Respondents had a mean (SD) of 4.2 (2.7) comorbidities and 2.3 (2.8) difficulties with activities of daily living (measured on a 0-12 scale). FIDE-SNPs enrolled more beneficiaries aged 85 years or older (eg, FIDE-SNP: 59.0% [95% CI, 58.0%-59.9%]; coordination-only D-SNP: 16.1% [95% CI, 15.3%-16.8%]), living with a caregiver (eg, FIDE-SNP: 56.6% [95% CI, 55.3%-58.0%]; coordination-only SNP: 15.3% [95% CI, 14.3%-16.2%]), and FIDE-SNP beneficiaries had more comorbidities (mean [SD], FIDE-SNP: 4.6 [2.7]; coordination-only SNP: 4.1 [2.7]) and higher scores of difficulties with activities of daily living (mean [SD], FIDE-SNP: 3.1 [3.1]; coordination-only SNP: 2.1 [2.6]) vs beneficiaries with other plan types. In counties offering FIDE-SNPs, 38.4% (95% CI, 37.5%-39.3%) of individuals in areas with the greatest socioeconomic disadvantage were enrolled in coordination-only D-SNPs and 41.3% (95% CI, 40.2-42.4) were enrolled in FIDE-SNPs. In areas with the least socioeconomic disadvantage, 32.0% (95% CI, 31.3%-32.8%) of respondents were enrolled in coordination-only D-SNPs and 43.2% (95% CI, 42.4%-43.9%) respondents were enrolled in FIDE-SNPs. Most differences remained in multivariate analyses. Conclusions and Relevance: In this cross-sectional study of full-benefit dual-eligible beneficiaries, substantial health burdens were reported, with notable differences across plan types. These findings highlight the need for tailored interventions to improve care and further research to understand MA plan selection in this population.