The importance and challenge of comparing stroke care, utilization and outcomes in Medicare Advantage and Fee-for-Service Medicare: a narrative review and vision for the future
Publication: Journal of Comparative Effectiveness Research
Abstract
Stroke prevalence is highest in adults ≥65 years, the majority of whom are Medicare beneficiaries. Fee-for-Service Medicare (FFS) incentivizes utilization by paying for each service. Medicare Advantage (MA) uses capitated payments to reduce overutilization. It is not clear if stroke patients with FFS or MA receive different stroke preventive care and whether those differences are associated with differences in post-acute care utilization, cost and clinical outcomes. We performed an empirical narrative review of published peer-reviewed studies in the PubMed, EMBASE and Web of Science databases comparing stroke preventive care between FFS and MA using the American Heart Association’s Life's Essential 8 and American Heart Association/American Stroke Association national guidelines. We added atrial fibrillation (AF), post-acute care utilization and outcomes, including mortality. 7/1356 studies met inclusion criteria. Studies were heterogenous in their design and settings. There was limited availability of clinical data. Within those limitations, published studies suggest that MA appears to allow for guideline-directed stroke preventive care for hyperlipidemia, smoking cessation and AF in specific study populations. Post-acute care utilization was generally lower in MA. Functional outcomes improvements were similar but occurred in fewer days in MA, though the absence of acute stroke treatment data is notable. Mortality data were mixed. Given the importance of stroke in Medicare and the growth in MA enrollment, comparing the effectiveness of MA and FFS warrants further study among appropriately matched MA and FFS beneficiaries with stroke.
Plain language summary
What is this article about?
Stroke is a leading cause of long-term disability and mortality in the US. Most US stroke patients are Medicare beneficiaries, and Medicare pays for most US stroke care. However, little is known about whether growing enrollment in Medicare Advantage (MA) impacts stroke patients’ access to preventive care, access to post-acute care, or their outcomes. In this narrative review, we examine peer reviewed studies that compare stroke care in MA and Fee-for-Service Medicare.
What was found?
Heterogeneity in study design, study settings and reporting of patient characteristics limit broad comparisons. Within those limits, published studies suggest that MA allows for access to stroke preventive care in specific guideline-directed categories. Post-acute care utilization is lower in MA than Fee-for-Service, but functional gains appear similar. Hospital readmission rates are lower in MA, while rates of community living are higher.
Why is this important?
Further research is needed to clarify these dynamics, including the degrees to which differences in prestroke health status, level of social support, access to acute stroke treatment and insurance networks may influence differences in outcomes.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
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© 2026 The authors. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
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Received: 30 September 2025
Accepted: 18 December 2025
Published online: 12 January 2026
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The importance and challenge of comparing stroke care, utilization and outcomes in Medicare Advantage and Fee-for-Service Medicare: a narrative review and vision for the future. (2026) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2025-0157
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