Racial and Ethnic Health Inequities and Medicare

The CMS Medicare Current Beneficiary Survey (MCBS) 2018 Survey File was used to describe Medicare beneficiary characteristics, supplemental coverage, and access to care. The analysis on supplemental coverage was limited to beneficiaries enrolled in Part A and Part B for most months of the year, excluding those with Part A or Part B only and Medicare as a Secondary Payer for most months of the year. The MCBS 2018 Cost Supplement File was used to describe service utilization among Medicare beneficiaries in fee-for-service (FFS).

Analysis on Medicare Part D enrollment was based on prescription drug event claims data from a sample of Medicare beneficiaries (20% sample for 2018) from the CMS Chronic Conditions Data Warehouse (CCW).

The CMS Office of Minority Health’s Mapping Medicare Disparities Tool, which uses 2018 administrative claims data from the Chronic Conditions Warehouse, was used to describe emergency department visit rates. This data was limited to Medicare beneficiaries enrolled in FFS. Medicare Advantage enrollees were excluded from this analysis because claims data are not available for these beneficiaries.

The CMS Office of Minority Health’s report, Impact of Hospital Readmissions Reduction Initiatives on Vulnerable Populations, which uses 2016 administrative claims data from the CCW, was used to describe 30-day hospital inpatient readmissions in Medicare FFS beneficiaries.

Urban Institute’s Dynamic Simulation of Income Model (DYNASIM4) was used to describe Medicare beneficiaries’ income and assets in 2019. Detailed methodology is previously discussed here.

The 2018-2020 Current Population Survey March Annual Social and Economic Supplement (CPS ASEC) was used to provide subgroup estimates of poverty under the official and supplemental poverty measure over the period of 2017-2019. The 2020 CPS-ASEC was used to produce poverty rates for all older adults in 2019 The poverty rates presented in this analysis apply to the non-institutionalized Medicare population. The CPS ASEC poverty thresholds are different from the Health and Human Services (HHS) poverty guidelines (sometimes referred to as the “federal poverty level”). Detailed methodology is previously discussed here.

Data from the U.S Census Bureau’s 2017 National Population Projection Main Series was used for U.S population estimates among people ages 65 and over.

Elizabeth Arias and Jiaquan Xu, “United States Life Tables, 2018” National Vital Statistics Reports 69, no. 12 (November 2020) was used to describe life expectancy at age 65 by race and gender.

Data on COVID-19 cases and hospitalization rates among Medicare beneficiaries were obtained from CMS’ Preliminary Medicare COVID-19 Data Snapshot ( https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot).

Data on COVID-19 deaths among adults ages 65 and over were obtained from the Centers for Disease Control and Prevention, “Deaths involving coronavirus disease 2019 (COVID-19) by race and Hispanic origin group and age, by state” as of February 3, 2021 ( https://data.cdc.gov/NCHS/Deaths-involving-coronavirus-disease-2019-COVID-19/ks3g-spdg). The CDC WONDER online database was used to obtain 2019 U.S Census Bureau single-race population estimates in order to calculate death rates per 100,000 people.