Study: Medicare Advantage Beneficiaries Experience 33% Fewer ER Visits

July 2018

man at the pool

A new study by health research firm Avalere Health shows that people with Medicare Advantage plans experienced up to 33 percent fewer emergency room visits and 23 percent fewer hospital stays than individuals enrolled in the a fee-for-service Medicare insurance plan.

Medicare Advantage plans serve as an alternative option to Original Medicare (Medicare Part A and Part B), and some Medicare Advantage plans offer additional health care services and benefits. These extra benefits can include coverage for prescription drugs, dental, vision and hearing care, along with disease management, wellness programs and medical help hotlines. Around one-third of Medicare beneficiaries are enrolled in a Medicare Advantage plan.1

The study, which was funded by the Better Medicare Alliance, looked at 1.5 million Medicare Advantage plan holders and 1.2 million Original Medicare beneficiaries, all of whom live with chronic conditions like high blood pressure, high cholesterol and diabetes. 

Lower costs of services and better coordination of care were identified as possible reasons for the drop in ER and hospital visits by Medicare Advantage patients. Medicare Advantage plans also make more effort to encourage people to see a primary care doctor and thus have higher rates of preventive screenings and tests, which may have also contributed to the results. 

The rate of ER visits in the study was 511 per 1,000 people with Medicare Advantage plans, compared to 759 per 1,000 people with Original Medicare. For inpatient hospital stays, the rate was 249 per 1,000 people with Medicare Advantage and 324 per 1,000 with Original Medicare.2

 

1 Medicare Advantage Fact Sheet. Oct. 10, 2017. Henry J. Kaiser Family Foundation. Retrieved from www.kff.org/medicare/fact-sheet/medicare-advantage.
2 Medicare Advantage Achieves Cost-Effective Care and Better Outcomes for Beneficiaries with Chronic Conditions Relative to Fee-for-Service Medicare. July 11, 2018. Avalere Health. Retrieved from http://avalere.com/expertise/managed-care/insights/medicare-advantage-achieves-better-health-outcomes-and-lower-utilization-of.

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