Exhibit 4:

Racial and ethnic differences in dual eligibles’ access to, use of, and satisfaction with care in Dual Eligible Special Needs Plans, other Medicare Advantage plans, and traditional Medicare

	Adjusted differences among dual eligibles of color a		Adjusted differences among Non-Hispanic White dual eligibles a		Comparison of adjusted differences by race and ethnicity b
Outcome	D-SNPs vs. traditional Medicare	D-SNPs vs. other Medicare Advantage	D-SNPs vs. traditional Medicare	D-SNPs vs. other Medicare Advantage	D-SNPs vs. traditional Medicare	D-SNPs vs. other Medicare Advantage
	Estimates (percentage points)
Access to care
Able to get care when needed	−0.9	1.3	2.2	2.3	−3.2	−1.0
Has a primary care provider	2.5	−1.0	3.5	−0.2	−1.0	−0.8
Able to get dental care when needed c	−1.2	−0.4	7.7**	10.7**	−8.9*	−11.1*
Use of preventive care
Blood pressure check in last 1 year	0.7	1.6	2.4**	−1.1	−1.6	2.7
Blood cholesterol check in last 1 year	0.4	−2.3	4.6**	−3.0	−4.2*	0.7
Influenza immunization last winter	7.9***	6.6*	1.1	−5.5	6.8	12.1**
Emergency department use
No emergency department visits in last 1 year d	−3.3	−2.4	0.6	3.3	−3.8	−5.7
Satisfaction with care
Satisfied with overall quality of care	0.4	−0.9	4.0***	3.3*	−3.6*	−4.2*
Satisfied with out-of-pocket health care costs	3.8**	6.0**	6.5****	6.9***	−2.7	−0.9
Satisfied with information given about health problems	−0.4	−2.5	2.5	0.7	−2.9	−3.2
Satisfied with ease of getting answers by phone about treatment or medications	−0.2	−3.2	4.5*	0.4	−4.7	−3.6
Satisfied with ease and convenience of getting to doctor from home	3.2**	−0.5	4.7***	5.3**	−1.6	−5.9**
Satisfied with availability of care from specialists	0.5	−1.3	5.0***	10.7****	−4.5**	−12.0****

Statistical significance is denoted as follows:

^*P<0.10,

^**P<0.05,

^***P<0.01,

^****P<0.001.

^aRegression-adjusted differences between Dual Eligible Special Needs Plans (D-SNPs), traditional Medicare, and other Medicare Advantage plans not exclusively serving dual eligibles, among dual eligibles of color (left pair of columns) and non-Hispanic White dual eligibles (middle pair of columns). Estimates adjusted for covariates in Exhibit 1, annual supply of physicians per 1,000 county residents, annual supply of dentists per 1,000 county residents, state fixed effects, and year fixed effects, and weighted by a composite of propensity score weights and survey weights. Statistical significance tests conducted using robust standard errors clustered at the respondent level to account intra-person correlation over time. MCBS respondents who did not report their race or ethnicity were excluded.

^bColumns report a comparison of two differences: (1) the adjusted difference in outcomes between D-SNPs and other Medicare coverage (i.e., traditional Medicare and other Medicare Advantage plans) among dual eligibles of color, compared with (2) the analogous difference among non-Hispanic White dual eligibles. Positive numbers indicate that the adjusted difference between D-SNPs and other Medicare coverage is greater among dual eligibles of color, relative to the analogous difference among non-Hispanic White dual eligibles. For example, we estimated that dual eligibles of color were 12.1 percentage points more likely to have received a flu vaccination in D-SNPs than in other Medicare Advantage plans, compared with the analogous difference among non-Hispanic White dual eligibles. Negative numbers indicate that the adjusted difference between D-SNPs and other Medicare coverage is smaller among dual eligibles of color than among non-Hispanic White dual eligibles. For example, we estimated that dual eligibles of color were 12.0 percentage points less likely to be more satisfied with the availability of care from specialists in D-SNPs than other Medicare Advantage plans compared to the difference among non-Hispanic White dual eligibles.

^cQuestion not asked in the 2015 MCBS.

^dQuestion was asked only of new survey respondents in the 2015 and 2016 MCBS.

Source: Authors’ analyses of the MCBS from 2015–2019.