Healthcare Access, Use, Affordability, and Satisfaction Among Adults With Cardiovascular Conditions After Enrollment in Medicare Advantage Versus Traditional Medicare

BACKGROUND: Cardiovascular disease is highly prevalent among older adults and remains a leading cause of morbidity and mortality in Medicare. Medicare Advantage (MA)-the managed care alternative to traditional Medicare (TM)-offers adults integrated care and supplemental benefits that may improve outcomes and satisfaction for this high-risk population. METHODS: We used longitudinal data from the National Health and Retirement Study (2010-2022) and an event-study, difference-in-differences design to compare changes in self-reported measures of health care access, utilization, affordability, and satisfaction among adults with cardiovascular conditions newly enrolling in MA versus TM (exposure) at 65 years. Eligible adults had a self-reported history of hypertension, diabetes, hyperlipidemia, heart disease, or stroke. RESULTS: A total of 3312 adults with cardiovascular conditions newly enrolled in Medicare, 34.3% in MA (mean age, 63.6 years; 60.5% female) and 65.7% in TM (mean age, 63.5 years; 56.5% female). Following enrollment, there were no differential changes in health care access or utilization between MA and TM at any follow-up time point. However, new MA enrollees experienced relative improvements in affordability compared with their TM counterparts, including greater reductions in trouble affording medical care (difference-in-differences estimate -6.6 percentage points [95% CI, -12.0 to -1.3]) and trouble affording prescription medications (difference-in-differences estimate -4.6 pp [95% CI, -9.2 to -0.2]) by the end of follow-up. Satisfaction with care increased in both groups but with larger gains among MA enrollees (difference-in-differences estimate at the end of follow-up +11.3 pp [95% CI, 5.2-17.4]). CONCLUSIONS: For adults with cardiovascular conditions transitioning into Medicare at 65 years, enrollment in MA was associated with greater improvements in affordability and satisfaction compared with TM. These findings may inform coverage decisions for this high-risk population, though generalizability to older beneficiaries or those with more advanced disease remains uncertain.