Abstract
INTRODUCTION: The Medicare Advantage (MA) payment system gives rise to incentives for plans to attract and retain beneficiaries from minoritized racial and ethnic groups and those dually eligible for Medicaid (duals) by offering these groups additional benefits. METHODS: We examined how MA plans respond to these incentives using a 2020 policy change that granted broader flexibility in benefit design, allowing plans to offer Special Supplemental Benefits for the Chronically Ill (SSBCI). RESULTS: We found that plans with higher shares of patients from these groups were more likely to offer SSBCI benefits: a 1 SD increase in a plan's non-White share was associated with a 20.8% point (P < .01) increase in the probability that the plan offered any SSBCI benefit. We found stronger associations in more competitive markets and for groups that can be more easily targeted with additional benefit offerings. We also found that Special Needs Plans (SNPs), which largely enroll duals, are more likely to offer SSBCI benefits than non-SNPs. CONCLUSION: These findings are consistent with the potential for population-based payment systems to shift resources towards underserved groups in ways that could encourage plans or providers to mitigate health care disparities; they also highlight the challenges and tradeoffs involved.