Abstract
BACKGROUND: Adults with heart failure-the majority of whom are covered by Medicare-often face barriers to accessing affordable medical care and prescription medications. Medicare Advantage (MA), the private plan alternative to traditional Medicare (TM), has expanded rapidly and now covers millions of individuals with heart failure nationwide. Therefore, understanding whether access and affordability to health care differ for patients with heart failure who have coverage from MA vs TM is critically important. METHODS: This was a cross-sectional study of Medicare beneficiaries with heart failure using the Medicare Current Beneficiary Survey 2018-2022. RESULTS: The study population included 1487 respondents with heart failure, corresponding to a weighted national total of 5,875,323 beneficiaries (44.4% MA, 55.6% TM). Measures of access to medical care and prescription medications were largely similar between MA vs TM beneficiaries with heart failure. However, MA beneficiaries with heart failure reported greater difficulty affording health care, including being more likely to delay care due to costs (14.1% vs 8.5%, adjusted difference [AD], 5.32 percentage points [pp]; 95% CI, 0.57pp-10.08pp) and to skip doses of medications to make them last longer (9.6% vs 6.7%; AD, 5.74pp; 95% CI, 0.90pp-10.58pp) compared with their counterparts in TM. In addition, MA beneficiaries with heart failure were less satisfied with the overall quality of their medical care (46.4% vs 56.6%; AD, -10.60pp; 95% CI, -120.71pp to -0.48pp), but more satisfied with their prescription medication coverage across three of the four measures. CONCLUSIONS: In this nationally representative study of Medicare beneficiaries with heart failure, those enrolled in MA reported more trouble affording both medical care and prescription medications and were overall less satisfied with their care compared with those in TM. As enrollment in MA grows, policy efforts should focus on ensuring care is affordable for patients with heart failure.