Number 53 n May 3, 2012

Health Characteristics of Medicare Traditional Fee-forService and Medicare Advantage Enrollees: 1999–2004
 

National Health and Nutrition Examination Survey
 

Linked to 2007 Medicare Data
 by Lisa B. Mirel, M.S., Division of Health and Nutrition Examination Surveys; Gloria Wheatcroft, M.P.H.,

Jennifer D. Parker, Ph.D., and Diane M. Makuc, Dr. P.H., Office of Analysis and Epidemiology

Abstract

Background—National Health and Nutrition Examination Survey (NHANES)

records have been linked to health care use and expenditure information from

Medicare records. Claims data are generally available only for traditional fee-forservice (FFS) enrollees and not for Medicare Advantage enrollees. Differences in

health characteristics between Medicare Advantage and traditional FFS enrollees

could affect conclusions from analyses of the linked files that are restricted to

traditional FFS enrollees.

Methods—Data from the 1999–2004 NHANES linked to the 2007 Medicare

enrollment data were analyzed. Using examination and interview data collected in

NHANES, we compared health characteristics of Medicare beneficiaries aged 65

and over at the NHANES interview by their type of Medicare enrollment in 2007.

Results—We found that the overall percentage of Medicare beneficiaries who

had hypertension at the time of the NHANES medical examination was lower for

Medicare Advantage enrollees compared with traditional FFS enrollees; this was

found for the non-Hispanic white population but not for other race and ethnicity

groups. We found no statistically significant differences between Medicare

Advantage and traditional FFS enrollees overall or within race and ethnicity groups

for other health characteristics that were measured or reported at the time of the

NHANES interview or medical examination in 1999–2004.

Conclusions—Despite finding no large differences in health characteristics by

Medicare enrollment in this analysis, users of the National Center for Health

Statistics Medicare linked files should consider potential differences in health

characteristics between Medicare Advantage and traditional FFS enrollees that could

influence results limited to traditional FFS beneficiaries only.

Keywords: data linkage • Centers for Medicare & Medicaid Services • national

health survey

Introduction

Managed care plans have been an

option for Medicare beneficiaries since

the early 1970s. Enrollment in managed

care plans has fluctuated greatly,

influenced by policy changes instituted

by Congress. For example, before 1996

fewer than 10% of Medicare

beneficiaries were enrolled in Medicare

Advantage; this increased to 14% in

1997 and 20% in 2007 (1). Both the

Balanced Budget Act of 1997 and the

Medicare Modernization Act of 2003 led

to sharp increases in the number of

private plans offered and in the number

of enrollees in Medicare Advantage

plans. A 2010 report shows that

Medicare beneficiaries enrolled in

Medicare Advantage plans, also referred

to as Managed Care Organization

(MCO) or Medicare Part C plans, tend

to differ from beneficiaries enrolled in

traditional fee for service (FFS) by

region and urbanicity (2). Other studies

have compared quality of care (3,4),

health care access (5,6), and health

outcomes (7–9) between the programs.

Some studies have indicated that

Medicare beneficiaries who opt into

Medicare Advantage plans are healthier

than those who do not (10–12).

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 53 n May 3, 2012

The National Center for Health

Statistics’ (NCHS) survey records have

been linked to Medicare claims records

in order to add a longitudinal

component to the surveys and increase

the research potential of NCHS’ survey

data. However, a potential limitation of

these linked files is that the Centers for

Medicare & Medicaid Services (CMS)

receives Medicare claims records, which

provide information about health care

use and expenditures for beneficiaries

enrolled in traditional FFS, but does not

generally receive claims records for

beneficiaries enrolled in Medicare

Advantage plans. Consequently, analysts

must decide how to handle periods of

beneficiary enrollment in Medicare

Advantage when analyzing NCHS

survey data linked to Medicare claims,

and generally restrict the analytic

sample to traditional FFS beneficiaries

with claims data during part or all of the

analytic period. Differences in health

and other characteristics between

Medicare Advantage and traditional FFS

enrollees could affect results and

inferences from analyses that are

restricted to traditional FFS

beneficiaries.

This report compares demographic

and health characteristics from the

1999–2004 National Health and

Nutrition Examination Survey

(NHANES) for Medicare Advantage and

traditional FFS enrollees in 2007. To

date, physical examination data have not

been used to compare the health status

of enrollees in Medicare Advantage

plans and traditional FFS.

Methods

We use the 1999–2004 NHANES

data linked to the 2007 Medicare data.

The only Medicare information used in

this analysis is type of Medicare

enrollment during 2007 from the

Medicare Denominator file. There may

have been up to 8 years or as few as 3

years between the time of exam or

interview and the 2007 type of Medicare

enrollment information. The NHANES

data are currently linked to 1999–2007

Medicare data, and therefore Medicare

Advantage enrollment can be assessed at

multiple time points using the linked

data files. We focus on 2007 because it

is currently the most recent year of

Medicare data available on the linked

file, emphasizes the longitudinal aspect

of the linked data file, and provides

sufficient numbers of observations for

the analysis. In addition, the Medicare

Advantage program in earlier years

differs from the program in 2007, thus,

incentives to enroll in Medicare

Advantage in 2007 may differ from

incentives in earlier years (13).

The analytic sample includes

linkage eligible 1999–2004 NHANES

respondents who were aged 65 and over

at interview, were examined, alive on

January 1 2007, and matched to the

2007 Medicare Denominator file.

Information about vital status of

NHANES respondents was obtained

using the linked 1999–2004 NHANES

Linked Mortality files (14) and those

who died in the interval from the

baseline NHANES interview to

December 31, 2006, were excluded from

this analysis (n=709).

Briefly, linkage eligibility means

that the survey respondent provided

sufficient personally identifiable

information (PII) or did not refuse to

Did not match at any time

to 1999–2007 Medicare 

Denominator files 

n=54 (1.6% of linkage 

eligible) 

Died before 2007 

n= 709 (21.6% of 

linkage eligible) 

Matched to the 2007 

Medicare Denominator file 

n=2,516 (76.7% of linkage 

eligible) 

Linkage ineligible 

n=531 (13.9%) 

Linkage eligible 

n=3,279 (86.1%) 

NHANES participants 

>=65 years of age

 n=3,810 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers 

for Medicare & Medicaid Services data. 

Figure 1. Analytic sample for NHANES 1999–2004 participants linked to the 2007 Medicare

Denominator file

provide their Social Security number

(SSN) or Health Insurance Claim

number during the NHANES interview,

thus, allowing their records to be linked

(15). Because not all NHANES

respondents are linkage eligible, these

files have an additional layer of

‘‘non-response’’ from the survey.

Some participants who were alive

on January 1, 2007, and linkage eligible

did not match at any time to the CMS

files (n=54). This could be because they

did not match exactly on date of birth,

SSN, or sex. The final analytic sample

had 2,516 participants (Figure 1).

An NHANES participant was

classified as enrolled in a Medicare

Advantage plan if he or she had at least

1 month of managed care enrollment in

2007. As a sensitivity analysis, we

recalculated the percentage enrolled in

Medicare Advantage after defining

Medicare Advantage enrollment as

enrollment as of December 31, 2007, for

comparability with a 2009 ResDac

report (16).

The health outcomes based on

NHANES examination data are:

hypertension, hypercholesterolemia, and

obesity. The health outcomes based on

NHANES interview data are: self­
Percent 

50 

45 

40 

35 

30 

25 

20 

15 

10 

5 

0 

Overall 65–74 years 75–84 years 85 years Male Female Non-Hispanic Non-Hispanic Mexican 

and over white black American 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data. 

National Health Statistics Reports n Number 53 n May 3, 2012	 Page 3

reported health status, and ever

diagnosed diabetes, coronary heart

disease, and cancer. The estimated

prevalence of these health outcomes is

shown overall and by type of Medicare

enrollment. Because health outcomes

and Medicare enrollment are known to

vary by race and ethnicity, additional

estimates are provided for the three race

and ethnicity groups, non-Hispanic

white, non-Hispanic black, and Mexican

American.

Statistical analyses were conducted

using the SAS System for Windows

(release 9.2; SAS Institute Inc., Cary,

N.C.) and SUDAAN (release 10.0;

Research Triangle Institute, Research

Triangle Park, N.C.). All analyses

included sample examination weights

from NHANES that accounted for the

unequal probabilities of selection and

nonresponse. The statistical weights

were further adjusted for linkage

‘‘non-response’’; this included adjusting

for 1999–2004 NHANES respondents

who could not be linked, who had died

in the interval, or did not have data on

the 2007 Medicare Denominator file

(17). All estimates incorporated the

adjusted sample weights and variance

calculations accounted for the complex

sample design of the survey, using

Taylor series linearization. All

significance tests were evaluated using a

two-sided p-value <0.05 as the level of

statistical significance. Unless otherwise

specified, statements such as ‘‘less

likely’’ or ‘‘more likely’’ are based on

statistical significance tests using a

Chi-square distribution. Estimates

presented have a relative standard error

less than or equal to 30% and greater

than or equal to 12 degrees of freedom,

unless otherwise noted. No estimates for

the Mexican-American population

enrolled in Medicare Advantage met

both of these criteria. In the figures and

tables, unknown values (responses coded

as ‘‘refused’’ or ‘‘don’t know’’) were not

counted in the denominators when

calculating estimates.

For more information on NHANES

and definition of terms see the

‘‘Technical Notes’’ section.

Results

Medicare Advantage plan

enrollment in 2007

+	 An estimated 25% of Medicare

beneficiaries aged 65 and over at the

time of their NHANES interview

were enrolled in a Medicare

Advantage plan for 1 or more months

in 2007 (Table 1, Figure 2).

+	 There were no differences in the

percentage with Medicare Advantage

plan enrollment by age or sex.

+	 Non-Hispanic white beneficiaries

were less likely (24%) to be enrolled

in a Medicare Advantage plan than

non-Hispanic black (35%) and

Mexican-American (33%)

beneficiaries.

Hypertension and

hypercholesterolemia by

type of Medicare enrollment

+	 Overall, about 70% of Medicare

beneficiaries aged 65 and over in

NHANES had hypertension. The

percentage with hypertension was

Figure 2. Percentage enrolled in a Medicare Advantage plan in 2007, among Medicare beneficiaries aged 65 and over at NHANES

interview, by demographic characteristics: 1999–2004 NHANES linked to the 2007 Medicare data
70 

80 

Percent 1

Denotes statistically significant difference between those in traditional fee for service and Medicare Advantage. 

2

 Hypertension is based on blood pressure examination data collected in the mobile examination center (MEC) with 

questionnaire data on blood pressure medication. Three brachial systolic and diastolic readings were obtained on each 

individual. Hypertension is defined as: (a) a mean systolic blood pressure (SBP) greater than or equal to 140 mm Hg or (b) a 

mean diastolic blood pressure greater than or equal to 90mm Hg or (c) report taking a high blood pressure medicine. 

3

 Hypercholesterolemia is based on laboratory data collected in the MEC with questionnaire data on prescription medication. 

Hypercholesterolemia is defined as: (a) total cholesterol greater than or equal to 240 mg/dL or (b) report taking prescribed 

medication to lower cholesterol. 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers 

for Medicare & Medicaid Services data. 

60 

50 

40 

30 

20 

10 

0 

Overall Medicare Advantage Fee for service 

Hypertension2 Hypercholesterolemia3 

1 

40 

Percent 

35 

30 

25 

20 

15 

10 

5 

0 

Overall Medicare Advantage Fee for service 

Obesity	 Diagnosed diabetes 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers 

for Medicare & Medicaid Services data. 

Page 4	 National Health Statistics Reports n Number 53 n May 3, 2012

higher for traditional FFS enrollees

Figure 3. Hypertension and hypercholesterolemia among Medicare beneficiaries aged 65

and over at NHANES interview, by type of Medicare enrollment in 2007

(72%) compared with Medicare

Advantage enrollees (65%)

(Figure 3).

+	 Among non-Hispanic white

beneficiaries, the percentage who had

hypertension was higher for

traditional FFS enrollees (72%)

compared with Medicare Advantage

enrollees (63%). For non-Hispanic

black and Mexican-American

beneficiaries, the percentage who had

hypertension was not significantly

different for traditional FFS and

Medicare Advantage enrollees

(Table 2).

+	 The estimated percentage of Medicare

beneficiaries from NHANES who had

hypercholesterolemia was 49%. The

percentage with hypercholesterolemia

was similar for Medicare Advantage

and traditional FFS enrollees

(Figure 3).

+	 Within each race and ethnicity group,

the percentage of beneficiaries with

hypercholesterolemia was not

significantly different for Medicare

Advantage and traditional FFS

enrollees (Table 3).

Obesity and diagnosed

diabetes by type of Medicare

plan enrollment

+ Overall, about one-third of Medicare

beneficiaries aged 65 and over in

NHANES were obese. The

percentage who were obese as

measured in NHANES was not

significantly different for Medicare

Advantage and traditional FFS

enrollees in 2007 (Figure 4).

+	 Similarly, within each race and

ethnicity group, the percentage of

beneficiaries who were obese was not

significantly different for Medicare

Advantage and traditional FFS

enrollees (Table 4).

+	 Overall, 16% of Medicare

beneficiaries aged 65 and over in

NHANES had diagnosed diabetes.

The percentage with diagnosed

diabetes did not differ significantly

between Medicare Advantage and

traditional FFS enrollees overall, or

Figure 4. Obesity and diagnosed diabetes among Medicare beneficiaries aged 65 and over within each race and ethnicity group

at NHANES interview, by type of Medicare enrollment in 2007 (Table 5).
National Health Statistics Reports n Number 53 n May 3, 2012 Page 5

40
 

35
 

30
 

25
 

20
 

15
 

10
 

5
 

0
 

Figure 5. Fair or poor self-reported health status, coronary heart disease, and cancer

among Medicare beneficiaries aged 65 and over at NHANES interview, by type of

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers 

for Medicare & Medicaid Services data. 

Fair or poor health Coronary heart disease Cancer 

Overall Medicare Advantage Fee for service 

Percent 

Medicare enrollment in 2007

Self-reported health status,

coronary heart disease, and

cancer by type of Medicare

enrollment

+ Overall, about 23% of Medicare

beneficiaries aged 65 and over in

NHANES reported having fair or

poor health status. The percentage

who reported fair or poor health

status was not significantly different

between Medicare Advantage and

traditional FFS enrollees overall, or

within race and ethnicity groups

(Figure 5, Table 6).

+ The percentage of Medicare

beneficiaries aged 65 and over in

NHANES who had ever been

diagnosed with coronary heart disease

was 22%. The percentage of

Medicare beneficiaries who had

coronary heart disease did not differ

significantly between Medicare

Advantage and traditional FFS

enrollees overall, or within race and

ethnicity groups (Table 7).

+ Overall, 22% of Medicare

beneficiaries aged 65 and over in

NHANES had ever been diagnosed

with cancer. The percentage of

Medicare beneficiaries who had ever

been diagnosed with cancer did not

differ significantly between Medicare

Advantage and traditional FFS

enrollees overall, or within race and

ethnicity groups (Table 8).

Discussion

Our analysis using the linked

1999–2004 NHANES and 2007

Medicare data, showed an estimated

25% of Medicare beneficiaries from

NHANES were enrolled in a Medicare

Advantage plan in 2007. With respect to

the specific health characteristics

measured in the 1999–2004 NHANES

that we examined in this report, there

was little difference between

beneficiaries enrolled in Medicare

Advantage and traditional FFS enrollees

in 2007. We found that the percentage

of Medicare beneficiaries who had

hypertension at the time of the

NHANES medical examination was

lower for Medicare Advantage enrollees

compared with traditional FFS enrollees

in 2007. However, this was not the case

for other health characteristics; the

percentage of beneficiaries with

hypercholesterolemia, obesity, diagnosed

diabetes, self-report of fair or poor

health, diagnosed coronary heart disease,

and diagnosed cancer did not differ

significantly between Medicare

Advantage and traditional FFS enrollees

in 2007. Furthermore, we found that

among non-Hispanic white beneficiaries,

the percentage who had hypertension

was lower for Medicare Advantage

enrollees compared with traditional FFS

enrollees, however, there were no other

statistically significant differences in

health characteristics by type of

Medicare enrollment within race and

ethnicity groups.

Some previous studies have found

differences between Medicare

Advantage and traditional FFS enrollees

in mortality or self-reported health status

(10,18). However, we found no

statistically significant difference in

self-reported health status between

Medicare Advantage and traditional FFS

enrollees aged 65 and over. We focused

on common health risk factors and

conditions, three of which were

measured at the mobile examination

center (MEC). In addition to focusing

on some measures that have not

previously been compared, possible

reasons for our different findings could

be due to the design of the NHANES,

which samples noninstitutionalized

residents and requires an examination in

the MEC, random variation as measured

by the 95% confidence intervals (CI),

and the time gap between the

measurement of health characteristics

and Medicare enrollment. An additional

factor that may play a role could be the

definition of Medicare Advantage

enrollment. Our estimate of beneficiaries

enrolled in Medicare Advantage in 2007

(25%, 95% CI from 21% to 29.6%) is

slightly higher than other published

reports, including a 2009 report which

estimated that about 20% of all

Medicare beneficiaries were enrolled in

a Medicare Advantage plan on

December 31, 2007 (16). Our definition

of enrollment classified an NHANES

participant as enrolled in a Medicare

Advantage plan if he or she had at least

1 month of managed care enrollment in

the benefit year 2007 rather than

enrolled on December 31, 2007. Based

on the sensitivity analysis we conducted

using enrollment on December 31, 2007,

the percentage and 95% CI of

beneficiaries enrolled in a Medicare
Page 6	 National Health Statistics Reports n Number 53 n May 3, 2012

Advantage plan was 22.9% (95% CI

from 19.3% to 27.0%). Using this

alternative definition, comparisons of

health characteristics by type of

Medicare enrollment were similar to

those presented in the tables and figures.

In addition, we found no

statistically significant differences in

plan enrollment in 2007 by age at

interview or sex. However, similar to

previous studies, we did note differences

in plan enrollment by race and ethnicity

(12). These differences in enrollment

between race and ethnicity groups may

be a result, in part, of differences in

market penetration of Medicare

Advantage plans in urban and rural

areas (19). According to a Kaiser

Family Foundation Medicare Issue

Brief, ‘‘at the end of 2007, 22 percent of

all Medicare beneficiaries in urban

counties were enrolled in Medicare

Advantage, as opposed to only

10 percent of beneficiaries in rural

counties’’ (19).

Due to statistical power limitations,

this analysis could not assess whether

the comparisons between Medicare

Advantage and traditional FFS enrollees

differ after further stratification by

region, age, or other factors, or whether

the comparisons of diabetes prevalence

would be affected by inclusion of those

with undiagnosed diabetes based on the

morning fasting subsample as measured

at the NHANES medical examination.

An additional limitation of this study is

the time gap between the NHANES

interview or medical examination and

the administrative record. It is possible

that health characteristics in 2007 might

have been different than those measured

in NHANES in 1999–2004.

Although this analysis found no

large differences in health characteristics

by Medicare enrollment, users of the

NHANES and Medicare linked data

should still consider possible

implications of the lack of Medicare

claims data for Medicare Advantage

enrollees for their specific research

question in deciding how to treat

periods of Medicare Advantage

enrollment in their analysis and how to

interpret results. One analytic approach

is to include Medicare Advantage

enrollees for the time period prior to

entering Medicare Advantage and censor

them at the time that they enter

Medicare Advantage (20). Analyses,

using the NCHS survey—Medicare

linked files, have handled Medicare

Advantage enrollment in different ways.

Looker et al. utilized the NHANES III

data linked to Medicare claims and

mortality to estimate the risk of incident

hip fracture in adults aged 65 and over.

They excluded NHANES III survey

respondents if they were enrolled in a

Medicare managed care plan at the time

of their baseline examination in

NHANES III (21). This approach

resulted in the exclusion of 167 people

out of the 4,092 adults who were aged

65 and over. In another analysis Decker

et al. utilized the 1994–2005 National

Health Interview Survey (NHIS) linked

to Medicare claims data to study health

service use among individuals who were

uninsured before age 65. They excluded

respondents if they were not in

traditional FFS Medicare for at least 1

year before entering a managed care

plan. This resulted in excluding 719

individuals out of 6,139 who were alive

and eligible for Medicare Part A from

the 1994–2005 NHIS (22).

Exclusion of Medicare Advantage

enrollees may affect inferences and

conclusions drawn about the health or

health care utilization patterns of

Medicare beneficiaries that are

necessarily restricted to beneficiaries

enrolled in traditional FFS. Researchers

need to be clear that the analyses apply

to traditional FFS beneficiaries as has

been done for other studies based on

Medicare claims data (23). Although

inferences are generalizable to the

traditional FFS group, it may not be

appropriate to draw conclusions about

all Medicare beneficiaries.

To facilitate determining how to

handle Medicare Advantage enrollment

in their studies, NCHS has provided

researchers with tables showing the

unweighted percentage of survey

participants who were linked to the

different years of the Medicare

Denominator file and were enrolled in

Medicare Advantage by age at interview

(24). These tables can be used to

estimate the impact of Medicare

Advantage enrollees on analytic sample

sizes. Future research based on the

NHIS linked Medicare files will

compare self-reported health

characteristics of Medicare Advantage

with traditional FFS beneficiaries. The

larger sample size of the NHIS will

enable additional comparisons to be

made including a comparison of health

characteristics by type of Medicare

enrollment at the time of Medicare

enrollment.

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27. Rose GA, Blackburn H.

Cardiovascular survey methods.

World Health Organization

Monograph 56:1–88. 1986.
Page 8 National Health Statistics Reports n Number 53 n May 3, 2012

Table 1. Percent distribution and percentage enrolled in a Medicare Advantage plan in 2007, among Medicare beneficiaries aged 65 and

over at NHANES interview, by demographic characteristics: 1999–2004 NHANES linked to the 2007 Medicare data

Percent in

Percent Medicare

distribution Advantage (95%

(95% confidence confidence

Demographic characteristic n interval) interval)

All ............................................ 2,516 100.0 25.4 (21.3–30.0)
 

Age (years)

65–74 ......................................... 1,413 60.6 (57.4–63.6) 25.9 (20.9–31.7)

75–84 ......................................... 896 33.5 (31.0–36.1) 25.1 (20.8–29.8)

85+ ........................................... 207 6.0 (5.0–7.1) 22.0 (14.9–31.2)

Sex

Male. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,211 42.7 (40.6–44.7) 25.9 (21.3–31.0)

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,305 57.3 (55.3–59.4) 25.1 (20.8–29.8)

Race and ethnicity

Non-Hispanic white.................................. 1,568 88.7 (85.4–91.3) 24.0 (19.4–29.3)

Non-Hispanic black.................................. 321 8.3 (6.2–10.9) 35.0 (27.3–43.5)

Mexican American .................................. 493 3.0 (1.7–5.4) 33.1 (23.6–44.2)

NOTES: n is unweighted sample size. Percent is weighted percentage. Race and ethnicity excludes other Hispanic and other race (including multiracial) while all other demographic characteristics

include all race and ethnic groups.

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data.

Table 2. Percentage who had hypertension among Medicare beneficiaries aged 65 and over at NHANES interview, by type of Medicare

enrollment in 2007 and race and ethnicity

95% confidence

Race and ethnicity and type of Medicare enrollment n Percent interval

§,1 All race and ethnicities

Overall ......................................... 2,450 70.5 68.0–72.8

Medicare Advantage ................................. 708 65.0 59.2–70.4

Traditional FFS .................................... 1,742 72.3 70.0–74.5

Non-Hispanic white§

Overall ......................................... 1,532 69.2 66.1–72.2

Medicare Advantage ................................. 387 62.7 56.3–68.7

Traditional FFS .................................... 1,145 71.2 68.2–74.1

Non-Hispanic black

Overall ......................................... 312 84.2 78.6–88.6

Medicare Advantage ................................. 107 84.3 74.1–91.0

Traditional FFS .................................... 205 84.2 76.2–89.8

Mexican American

Overall ......................................... 476 68.7 62.8–74.0

Medicare Advantage2 ................................ 171 64.4 55.5–72.4

Traditional FFS .................................... 305 70.8 63.4–77.2

§ Denotes statistically significant difference between those in traditional fee for service (FFS) and Medicare Advantage.
 1

All race and ethnicities include other Hispanic and those who identified as other race and ethnicity, including multiracial.
 2

Indicates estimate is based on less than 12 degrees of freedom or relative standard error is greater than or equal to 30% but less than 40%.
 

NOTES: n is unweighted sample size for type of plan. Percent is weighted percentage in the plan with the health condition.
 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data.
 
National Health Statistics Reports n Number 53 n May 3, 2012 Page 9

Table 3. Percentage who had hypercholesterolemia among Medicare beneficiaries aged 65 and over at NHANES interview, by type of

Medicare enrollment in 2007 and race and ethnicity

95% confidence

Race and ethnicity and type of Medicare enrollment n Percent interval

All race and ethnicities1

Overall ......................................... 2,075 49.1 46.5–51.7

Medicare Advantage ................................. 603 48.8 43.0–54.7

Traditional FFS .................................... 1,472 49.2 45.8–52.6

Non-Hispanic white

Overall ......................................... 1,382 49.9 47.0–52.7

Medicare Advantage ................................. 346 49.5 43.1–56.0

Traditional FFS .................................... 1,036 50.0 46.3–53.7

Non-Hispanic black

Overall ......................................... 226 43.9 36.6–51.7

Medicare Advantage2 ................................ 84 49.2 38.0–60.4

Traditional FFS .................................... 142 40.8 32.2–49.9

Mexican American

Overall ......................................... 362 41.6 35.9–47.6

Medicare Advantage2 ................................ 138 44.3 35.2–53.8

Traditional FFS2

.................................... 224 40.2 33.8–46.9

1

All race and ethnicities include other Hispanic and those who identified as other race and ethnicity, including multiracial.
 2

Indicates estimate is based on less than 12 degrees of freedom or relative standard error is greater than or equal to 30% but less than 40%.
 

NOTES: n is unweighted sample size for type of plan. Percent is weighted percentage in the plan with the health condition. FFS is fee for service.
 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data.
 

Table 4. Percentage who were obese among Medicare beneficiaries aged 65 and over at NHANES interview, by type of Medicare

enrollment in 2007 and race and ethnicity

95% confidence

Race and ethnicity and type of Medicare enrollment n Percent interval

All race and ethnicities1

Overall ......................................... 2,376 30.4 28.0–32.8

Medicare Advantage ................................. 704 33.5 28.5–39.0

Traditional FFS .................................... 1,672 29.3 26.9–31.8

Non-Hispanic white

Overall ......................................... 1,479 29.6 26.8–32.5

Medicare Advantage ................................. 382 33.4 27.0–40.5

Traditional FFS .................................... 1,097 28.3 25.5–31.3

Non-Hispanic black

Overall ......................................... 298 45.0 38.6–51.6

Medicare Advantage ................................. 109 36.5 26.5–47.8

Traditional FFS .................................... 189 49.9 42.6–57.1

Mexican American

Overall ......................................... 474 32.0 27.1–37.2

Medicare Advantage2 ................................ 171 30.8 24.4–38.2

Traditional FFS .................................... 303 32.5 26.7–38.9

1

All race and ethnicities include other Hispanic and those who identified as other race and ethnicity, including multiracial.
 2

Indicates estimate is based on less than 12 degrees of freedom or relative standard error is greater than or equal to 30% but less than 40%.
 

NOTES: n is unweighted sample size for type of plan. Percent is weighted percentage in the plan with the health condition. FFS is fee for service.
 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data.
 
Page 10 National Health Statistics Reports n Number 53 n May 3, 2012

Table 5. Percentage who had diagnosed diabetes among Medicare beneficiaries aged 65 and over at NHANES interview, by type of

Medicare enrollment in 2007 and race and ethnicity

95% confidence

Race and ethnicity and type of Medicare enrollment n Percent interval

All race and ethnicities1

Overall ......................................... 2,515 15.6 13.7–17.8

Medicare Advantage ................................. 735 14.5 11.4–18.2

Traditional FFS .................................... 1,780 16.0 13.9–18.4

Non-Hispanic white

Overall ......................................... 1567 14.5 12.2–17.0

Medicare Advantage ................................. 400 12.8 9.6–17.0

Traditional FFS .................................... 1,167 15.0 12.6–17.7

Non-Hispanic black

Overall ......................................... 321 22.0 17.9–26.6

Medicare Advantage ................................. 113 22.9 16.2–31.4

Traditional FFS .................................... 208 21.4 16.5–27.4

Mexican American

Overall ......................................... 493 25.0 21.4–29.0

Medicare Advantage2 ................................ 178 21.0 15.7–27.6

Traditional FFS .................................... 315 26.9 20.7–34.3

1

All race and ethnicities include other Hispanic and those who identified as other race and ethnicity, including multiracial.
 2

Indicates estimate is based on less than 12 degrees of freedom or relative standard error is greater than or equal to 30% but less than 40%.
 

NOTES: n is unweighted sample size for type of plan. Percent is weighted percentage in the plan with the health condition. FFS is fee for service.
 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data.
 

Table 6. Percentage with fair or poor self-reported health status among Medicare beneficiaries aged 65 and over at NHANES interview,

by type of Medicare enrollment in 2007 and race and ethnicity

95% confidence

Race and ethnicity and type of Medicare enrollment n Percent interval

All race and ethnicities1

Overall ......................................... 2,406 22.7 20.0–25.5

Medicare Advantage ................................. 703 22.6 17.1–29.2

Traditional FFS .................................... 1,703 22.7 19.8–25.8

Non-Hispanic white

Overall ......................................... 1517 19.2 16.3–22.4

Medicare Advantage ................................. 393 17.7 12.7–24.3

Traditional FFS .................................... 1124 19.6 16.4–23.3

Non-Hispanic black

Overall ......................................... 298 37.5 32.4–43.0

Medicare Advantage2 ................................ 102 41.9 31.9–52.6

Traditional FFS .................................... 196 35.3 27.6–43.8

Mexican American

Overall ......................................... 468 47.3 42.7–51.9

Medicare Advantage2 ................................ 168 41.9 32.2–52.1

Traditional FFS .................................... 300 49.9 44.7–55.2

1

All race and ethnicities include other Hispanic and those who identified as other race and ethnicity, including multiracial.
 2

Indicates estimate is based on less than 12 degrees of freedom or relative standard error is greater than or equal to 30% but less than 40%.
 

NOTES: n is unweighted sample size for type of plan. Percent is weighted percentage in the plan with the health condition. FFS is fee for service.
 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data.
 
National Health Statistics Reports n Number 53 n May 3, 2012 Page 11

Table 7. Percentage who had ever been diagnosed with coronary heart disease among Medicare beneficiaries aged 65 and over at

NHANES interview, by type of Medicare enrollment in 2007 and race and ethnicity

95% confidence

Race and ethnicity and type of Medicare enrollment n Percent interval

All race and ethnicities1

Overall ......................................... 2,516 22.2 20.0–24.6

Medicare Advantage ................................. 736 19.7 15.6–24.6

Traditional FFS .................................... 1,780 23.1 20.4–26.1

Non-Hispanic white

Overall ......................................... 1,568 22.8 20.2–25.7

Medicare Advantage ................................. 401 20.5 15.6–26.5

Traditional FFS .................................... 1,167 23.6 20.5–27.0

Non-Hispanic black

Overall ......................................... 321 18.7 15.5–22.4

Medicare Advantage ................................. 113 18.2 11.4–27.8

Traditional FFS .................................... 208 19.0 14.8–24.1

Mexican American

Overall ......................................... 493 15.8 12.6–19.7

Medicare Advantage2 ................................ 178 17.5 12.1–24.6

Traditional FFS .................................... 315 15.0 11.7–19.2

1

All race and ethnicities include other Hispanic and those who identified as other race and ethnicity, including multiracial.
 2

Indicates estimate is based on less than 12 degrees of freedom or relative standard error is greater than or equal to 30% but less than 40%.
 

NOTES: n is unweighted sample size for type of plan. Percent is weighted percentage in the plan with the health condition. FFS is fee for service.
 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data.
 

Table 8. Percentage who had ever been diagnosed with cancer among Medicare beneficiaries aged 65 and over at NHANES interview, by

type of Medicare enrollment in 2007 and race and ethnicity

95% confidence

Race and ethnicity and type of Medicare enrollment n Percent interval

All race and ethnicities1

Overall ......................................... 2,512 22.4 20.3–24.6

Medicare Advantage ................................. 736 19.4 16.3–22.9

Traditional FFS .................................... 1,776 23.4 20.8–26.2

Non-Hispanic white

Overall ......................................... 1,566 24.7 22.3–27.2

Medicare Advantage ................................. 401 22.3 18.7–26.4

Traditional FFS .................................... 1,165 25.4 22.5–28.6

Non-Hispanic black

Overall ......................................... 320 9.5 6.6–13.7

Medicare Advantage ................................. 113 10.4 5.8–18.2

Traditional FFS .................................... 207 9.0 5.8–13.9

Mexican American

Overall ......................................... 492 7.2 5.3–9.9

Medicare Advantage2 ................................ 178 9.0 4.6–16.9

Traditional FFS .................................... 314 6.4 4.8–8.5

1

All race and ethnicities include other Hispanic and those who identified as other race and ethnicity, including multiracial.
 2

Indicates estimate is based on less than 12 degrees of freedom or relative standard error is greater than or equal to 30% but less than 40%.
 

NOTES: n is unweighted sample size for type of plan. Percent is weighted percentage in the plan with the health condition. FFS is fee for service.
 

SOURCE: CDC/NCHS, 1999–2004 National Health and Nutrition Examination Survey (NHANES) linked to the 2007 Centers for Medicare & Medicaid Services data.
 
Page 12 National Health Statistics Reports n Number 53 n May 3, 2012

Technical Notes

Data source

Currently NHANES is a continuous

survey (1999–present) that includes an

interview in the household followed by

a physical examination in a mobile

examination center (MEC). NHANES is

a representative cross-sectional sample

of the U.S. civilian, noninstitutionalized

population that is selected using a

complex, multistage probability design.

Detailed descriptions of the NHANES

sample design are available elsewhere

(25). The unweighted response rates for

the 1999–2004 NHANES interview and

examination were 81.7% and 77.2%,

respectively. The CMS Medicare

Denominator file (or Beneficiary

Summary file) provides data on all

Medicare beneficiaries enrolled or

entitled to Medicare benefits in a given

year. Monthly information on the

enrollment status of Medicare

beneficiaries including third party payer

information and managed care

organization plan enrollment information

is provided.

The linkage of NHANES to CMS

Medicare data was undertaken to

support various research initiatives.

NHANES respondents were eligible for

linkage to CMS Medicare administrative

records if they 1) provided sufficient

personally identifiable information, 2)

did not refuse to provide their SSN or

Health Insurance Claim number at the

time of the NHANES interview, and

they 3) had a SSN verified by the Social

Security Administration Enumeration

Verification System (17). There were

31,126 NHANES participants in

1999–2004 and about 83% (n=25,750)

were linkage eligible (17).

Definition of terms

Medicare Advantage plans—are

also referred to as Managed Care

Organization (MCO) or Part C plans.

Medicare Advantage enrollment is

defined using the Health Maintenance

Organization (HMO) indicator in the

Medicare Denominator file. The HMO

indicator refers to some type of

managed care enrollment, including cost

based and risk based plans. For this

analysis, the sample participant from

NHANES was classified as enrolled in a

Medicare Advantage plan if he or she

had at least 1 month of managed care

enrollment in the benefit year of 2007.

All Medicare beneficiaries who did not

meet the criteria for Medicare

Advantage plan enrollees were classified

as traditional fee-for-service (FFS)

enrollees.

Hypertension—is based on blood

pressure examination data collected in

the MEC with questionnaire data on

blood pressure medication. Three

brachial systolic and diastolic readings

were obtained on each individual.

Hypertension is defined as: (a) a mean

systolic blood pressure (SBP) greater

than or equal to 140 mm Hg, (b) a mean

diastolic blood pressure greater than or

equal to 90mm Hg, or (c) report taking

a high blood pressure medicine.

Hypercholesterolemia—is based on

laboratory data collected in the MEC

with questionnaire data on prescription

medication. Hypercholesterolemia is

defined as: (a) total cholesterol greater

than or equal to 240 mg/dL or (b) report

taking prescribed medication to lower

cholesterol.

Obesity—is calculated from

physical examination data collected in

the MEC as weight in kilograms divided

by height in meters squared, body mass

index (BMI). BMI category greater than

or equal to 30 was defined as obese

(26).

Diagnosed diabetes—is based on a

positive response to the following

question: ‘‘{Other than during

pregnancy, {have you}}{Have you}}

ever been told by a doctor or health

professional that{you have} diabetes or

sugar diabetes?’’

Self-reported fair or poor health—is

based on the NHANES questionnaire

data. The respondent is asked to classify

their health as excellent, very good,

good, fair, or poor. In 1999–2000 this

question was asked as part of the

‘‘Hospital Utilization and Access to

Care’’ section of the household

interview. In 2002–2004 this question

was asked as part of the current health

status questions collected at the MEC.

Diagnosed coronary heart

disease—is based on the NHANES

Medical Conditions, Cardiovascular

Disease and Prescription Medications

questionnaire. Diagnosed coronary heart

disease is defined as: (a) ever told that

had congestive heart failure or (b) ever

told that had coronary heart disease or

(c) ever told that had heart attack or

myocardial infarction or (d) ever told

that had angina or (e) Rose

questionnaire grade I angina (27) or (f)

took anti-angina medication in the last

30 days. Note: The Rose questionnaire

was not asked in 1999–2000 but has

been included in the definition for

participants from the NHANES

2001–2004. In addition, because

diagnosed congestive heart failure is

included, this may be a slight overestimate of diagnosed coronary heart

disease.

Diagnosed cancer—is based on

self-report from the medical conditions

questionnaire data, and defined as a

positive response to the following

question: ‘‘[Have you] ever been told by

a doctor or other health professional that

had cancer or a malignancy of any

kind?’’
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National Health Statistics Reports n Number 53 n May 3, 2012

Suggested citation

Mirel LB, Wheatcroft G, Parker JD, Makuc

DM. Health characteristics of Medicare

traditional fee-for-service and Medicare

advantage enrollees: 1999–2004 National

Health and Nutrition Examination Survey

linked to 2007 Medicare data. National

health statistics reports; no 53. Hyattsville,

MD: National Center for Health Statistics.

2012.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director
 

Jennifer H. Madans, Ph.D., Associate Director
 

for Science
 

Division of Health and Nutrition
 

Examination Surveys
 

Clifford L. Johnson, M.S.P.H., Director

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DHHS Publication No. (PHS) 2012–1250 • CS230449