Objectives: To examine whether enrollment in Medicare Advantage (MA) and fee-for-service traditional Medicare (TM) is differential by food insecurity and then examine differences in health care utilization, financial burden, care satisfaction, and health status between food-insecure enrollees in MA and TM and between food-secure enrollees in MA and TM.
Study design: We employed a retrospective cohort study design. Using the 2015-2016 Medicare Current Beneficiary Survey, we identified the following 4 mutually exclusive groups: food-insecure enrollees in MA, food-insecure enrollees in TM, food-secure enrollees in MA, and food-secure enrollees in TM.
Methods: We used an instrumental variable approach to address endogenous choice between MA and TM. Using a 2-stage least squares regression model, we estimated the adjusted outcomes for each group and differences in the adjusted outcomes between food-insecure enrollees in MA and TM and between food-secure enrollees in MA and TM.
Results: There were no significant differences in enrollment between MA and TM by food insecurity status. Compared with food-insecure enrollees in TM, food-insecure enrollees in MA had significantly lower health care utilization and financial burden. A similar pattern was observed among food-secure enrollees, but the difference in health care utilization was greater between food-insecure enrollees in MA and TM than between food-secure enrollees in MA and TM. There were no significant differences in care satisfaction and health status between MA and TM. However, food insecurity status did not improve in MA and TM enrollees over time.
Conclusions: MA may deliver care more efficiently to food-insecure beneficiaries than TM, but it is not better at reducing food insecurity.