Profile of Medicare Beneficiaries by Race and Ethnicity: A Chartpack

Medicare provides health insurance coverage for 55 million people ages 65 and over and younger adults with permanent disabilities. As the number of black and Hispanic beneficiaries has grown over time, the program has played an increasingly vital role as a source of coverage for people of color. Before the enactment of Medicare in 1965, health coverage and care was not easily accessible or affordable for many seniors, and perhaps least so for black seniors, who were often unable to receive treatment in the same facilities as whites because hospitals were segregated. The establishment of Medicare, in conjunction with the Civil Rights Act of 1964, was transformative in desegregating the nation’s health care system for patients and providers and in improving access to care.^1,2,3

Medicare has helped to mitigate disparities in treatment and health outcomes across racial and ethnic groups, but gaps remain.⁴ For example, life expectancy at age 65 has improved over the past several decades, but nonetheless is lower for blacks than whites.⁵ Prior research has documented racial and ethnic disparities in the use of certain preventive services and diagnostic screenings, such as flu shots and prostate cancer screenings,^6,7 in wait times for treatment, such as kidney transplants and cancer treatment,^8,9 and in rates of hospital readmissions.^10,11

Studies have also shown that among beneficiaries in Medicare Advantage plans, black and Hispanic enrollees are less likely than white enrollees to have their blood pressure, cholesterol, and glucose levels under control, though disparities in these clinical outcomes have lessened over time.^12,13,14 Health disparities among Medicare beneficiaries of different racial and ethnic groups are related to a number of factors associated with broad social determinants of health, such as housing, income, and education,^15,16 which affect health status and health outcomes long before the Medicare eligibility age is reached. Racial and ethnic disparities in care also have been attributed to variations in clinical treatment practices,¹⁷ differences in access to potentially higher-quality providers and facilities,^18,19,20 and geographic variation.²¹ In addition, disparities in care among Hispanic beneficiaries have been attributed to cultural and language barriers.^22,23,24

This chartpack draws on data and analysis from a variety of sources to profile the Medicare population through the lens of race and ethnicity, describing life expectancy, demographic characteristics, income and savings, health status and chronic conditions, supplemental coverage, selected measures of access to care, and service utilization (see “Data Sources” textbox below). In most cases, data are presented for the overall Medicare beneficiary population, and separately for white non-Hispanic, black non-Hispanic, and Hispanic Medicare beneficiaries. Sample size limitations generally preclude subgroup analysis of Asian, American Indian, Native Hawaiian or Pacific Islander beneficiaries.

Key Findings

• People of color accounted for about one-fifth of adults ages 65 and over in 2012—including 9 percent black, 7 percent Hispanic, 4 percent Asian, and 1 percent other races—while non-white Hispanics were 79 percent of the 65 and over population. By 2040, people of color will comprise about one-third of the U.S. population ages 65 and over.
• The distribution of Medicare beneficiaries by race and ethnicity varies considerably in states across the country. In 7 states (Alabama, Georgia, Louisiana, Maryland, Mississippi, North Carolina, and South Carolina), at least 20 percent of all Medicare beneficiaries are black—at least twice the national average—while in Washington, D.C., 68 percent of beneficiaries are black. The 5 states with the highest share of Hispanic beneficiaries are California, Florida, New Mexico, New York, and Texas.
• Life expectancy at age 65 has improved over the past several decades, but continues to vary by race and ethnicity. Life expectancy at 65 is lower for blacks than whites (18 years versus 19 years), but higher for Hispanics at age 65 (21 years) than for whites and blacks.
• Compared to white beneficiaries, black and Hispanic Medicare beneficiaries are more likely to be under the age of 65, have more limited financial resources, and report poorer health status.
  • The majority (83%) of Medicare beneficiaries are ages 65 and older, while 17 percent are under age 65 and qualify for Medicare because of a permanent disability. However, a much larger share of black (31%) and Hispanic beneficiaries (23%) than white beneficiaries (14%) are under age 65 and living with disabilities.
  • Median per person income in 2014 for black and Hispanic Medicare beneficiaries ($16,150 and $12,800, respectively) was considerably lower than for white Medicare beneficiaries ($27,450). In 2014, half of all Medicare beneficiaries had less than $63,350 in savings, but the amount of savings was seven times greater for white beneficiaries ($91,950) than black ($12,350) or Hispanic ($9,800) beneficiaries.
  • A larger share of black (37%) and Hispanic (36%) Medicare beneficiaries than white beneficiaries (24%) report fair or poor health status.
  • The prevalence of chronic conditions among Medicare beneficiaries varies widely by racial and ethnic groups. For example, a larger share of black (79%) and Hispanic (73%) beneficiaries have hypertension than white beneficiaries (66%), while heart conditions are more common among white beneficiaries.
• Close to half (45%) of all Hispanic beneficiaries were enrolled in Medicare Advantage in 2011, a far higher share than among black (29%) or white (26%) beneficiaries.
• Sources of supplemental insurance coverage vary by race and ethnicity, with a significantly smaller share of black (20%) and Hispanic (14%) beneficiaries having coverage from an employer-sponsored plan compared to white beneficiaries (32%) in 2011. Additionally, a larger share of black (28%) and Hispanic (22%) beneficiaries than white beneficiaries (11%) rely on Medicaid to supplement Medicare, based primarily on lower incomes among blacks and Hispanics. Nearly one in five (19%) black beneficiaries had no source of supplemental insurance in 2011, a larger share than among white beneficiaries (13%).
• Measures of access to care and utilization of services vary by race/ethnicity:
  • Overall, Medicare beneficiaries have broad access to physicians, hospitals, and other health care providers, and only a small share overall report problems with access to care. While only a small share of beneficiaries overall report access to care problems, a slightly larger share of black and Hispanic beneficiaries report trouble getting needed care (7% and 9%, respectively) than white beneficiaries (5%).
  • A larger share of black beneficiaries than white beneficiaries had at least one emergency department visit during the year in 2011 (37% versus 28%). This variation is likely related to a larger share of black beneficiaries reporting fair or poor health status; nonetheless, even among beneficiaries self-reporting good health, a larger share of black beneficiaries than white beneficiaries had at least one visit to the emergency department during the year (30% versus 22%).
  • In terms of preventive services, the share of beneficiaries receiving an influenza vaccination in 2011 was higher among white beneficiaries (72%) than among black (55%) and Hispanic beneficiaries (59%); there were no notable differences by race and ethnicity in receipt of other preventive services, such as mammograms and prostate cancer screenings, in 2011.

Discussion

It has now been three decades since Department of Health and Human Services Secretary Margaret Heckler issued a landmark report documenting “the sad and significant fact” of ongoing disparities in the burden of illness between non-Hispanic whites and people of color.²⁵ Since then, a number of efforts have been launched to measure and minimize these gaps.^26,27 Most recently, the U.S. Department of Health and Human Services has proposed a set of initiatives to reduce disparities in hospital readmissions rates and improve quality of care for racially and ethnically diverse beneficiaries.^28,29,30,31 Such efforts may help to address observed health disparities among Medicare beneficiaries of different racial and ethnic groups. Ultimately, achieving health equity for all Medicare beneficiaries will involve not only improving coverage for adults prior to age 65, but also addressing the specific cultural, linguistic, and socioeconomic needs of racially and ethnically diverse groups at all ages.

Data Sources Used in This Analysis

The Medicare Current Beneficiary Survey (MCBS) 2011 Cost and Use file and 2013 Access to Care file is used to describe Medicare beneficiary characteristics, supplemental coverage, access to care, and service utilization. The MCBS Cost and Use sample includes all beneficiaries, including those who are enrolled for the entire year, those who become eligible during the year, and those who die during the year; the 2011 file includes a total of 50.0 million beneficiaries, of whom 38.2 million are white, 4.7 million are black, and 4.5 million are Hispanic. The MCBS Access to Care sample includes only those beneficiaries who are enrolled for the entire year; the 2013 file includes a total of 48.9 million beneficiaries, of whom 36.6 million are white, 4.7 million are black, and 4.6 million are Hispanic. The DYNASIM microsimulation model developed by researchers at The Urban Institute is used to describe Medicare beneficiaries’ incomes and assets in 2014. The March 2015 Current Population Survey Annual Social and Economic Supplement is used to estimate poverty among people ages 65 and over under the official and supplemental poverty measures, and Medicare beneficiary population estimates by state (for calendar year 2014).  Data from the U.S. Census Bureau report, An Aging Nation: The Older Population in the United States, is used for U.S. population estimates among people ages 65 and over. Data from the Centers for Disease Control and Prevention, National Center for Health Statistics report, Health, United States, 2014, is used to describe life expectancy at age 65 by race and gender.