• Hansoo Ko, Ghaida Alsadah, and Gilbert Gimm.
• Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, USA.
• J Gen Intern Med. 2024 Dec 20.

BackgroundWith more than half of all beneficiaries enrolled in Medicare Advantage (MA) plans, ensuring access to high-quality MA plans is a key concern for policymakers. Access to high-quality MA plans may be limited in certain areas if private insurers are not willing to offer high-quality MA plans in local areas with greater unmet health-related social needs.ObjectiveThis study examined the association of a market-level social vulnerability index (SVI) score with the number of high-quality MA plans.DesignThis study conducted a retrospective cross-sectional study.ParticipantsOur analysis included 3113 USA counties in 2020.Main MeasuresOur primary outcome measure, the availability of high-quality MA plans at the market level, was defined by counting the raw number of 5-star plans, plans with 4.5 or higher stars, and plans with 4 or higher stars. We also counted the number of all MA plans at the market level as an outcome measure to explore private insurers' market entry and participation decisions.ResultsWe found evidence that fewer high-quality MA plans are available in markets with greater unmet social needs (higher SVI scores). Compared to the least vulnerable markets, the most vulnerable markets had 1.5 fewer MA plans overall [95%CI -2.9, -0.1]. The most vulnerable markets also had 1.1 fewer 4 or higher star plans [95%CI -1.9, -0.3] than the least vulnerable markets. Furthermore, this negative association was concentrated in the southern region, which has a greater proportion of Black/African Americans in its market-level populations.ConclusionAs historically marginalized groups are more likely to reside in markets with greater unmet social needs, disparities in access to high-quality MA plans may widen existing health disparities. Therefore, monitoring the availability of high-quality MA plans in areas with greater unmet social needs is needed to improve health equity for MA beneficiaries.© 2024. The Author(s).

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