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Medicare Advantage and Type 2 Diabetes Outcomes
Seth A Berkowitz1,2,3, Myklynn LaPoint2,3, Marlena L Kuhn4
1Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine.
JAMA Internal Medicine
|August 10, 2026
Summary
Medicare Advantage (MA) plans do not show better type 2 diabetes (T2D) outcomes or fewer social needs compared to original Medicare (OM). This study found no significant differences in HbA1c, blood pressure, or cholesterol levels between the two plans.
Area of Science:
- Health Services Research
- Chronic Disease Management
- Health Economics
Background:
- Medicare Advantage (MA) incurs higher costs than original Medicare (OM), with an estimated $83 billion in annual excess public spending.
- MA offers potential benefits like financial protections and supplemental services that could improve type 2 diabetes (T2D) outcomes.
Purpose of the Study:
- To determine if Medicare Advantage (MA) coverage is associated with improved type 2 diabetes (T2D) outcomes compared to original Medicare (OM).
- To assess the impact of MA on health-related social needs, including food insecurity, housing instability, and transportation barriers.
Main Methods:
- A longitudinal cohort study emulating a target trial design, analyzing data from adults aged 18+ with T2D enrolled in OM or MA.
- Follow-up occurred before and after Medicare coverage (January 2021 to June 2024) across 44 states, with analyses from September 2025 to May 2026.
- Statistical analysis utilized targeted minimum loss estimation to account for pre-coverage factors influencing MA vs. OM selection.
Main Results:
- In a cohort of 34,648 adults with T2D, MA was not associated with significant improvements in Hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), or LDL cholesterol at 12 months post-coverage.
- No significant differences were observed in HbA1c, SBP, DBP, or LDL cholesterol at 6, 18, and 24 months follow-up.
- MA coverage was not associated with a reduced risk of food insecurity, housing instability, or transportation barriers compared to OM.
Conclusions:
- After accounting for selection factors, Medicare Advantage (MA) did not demonstrate superior T2D outcomes or a reduction in health-related social needs compared to original Medicare (OM).
- Given the higher expenditure associated with MA, further investigation is warranted to ensure cost-effectiveness and improved health outcomes.
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