Total and Out-of-Pocket Costs Surrounding Emergency Department Care Among Older Adults Enrolled in Traditional Medicare and Medicare Advantage - 12/06/24
, Wafa Salah, BA a, Craig Rothenberg, MPH a, Yixuan Liang, BS c, Hope Schwartz, BA d, Kirstin W. Scott, MD, PhD e, Ula Hwang, MD, MPH a, f, g, Susan N. Hastings, MD, MHSc h, i, j, k, l, Arjun K. Venkatesh, MD, MBA a, bAbstract |
Study objective |
We sought to quantify differences in total and out-of-pocket health care costs associated with treat-and-release emergency department (ED) visits among older adults with traditional Medicare and Medicare Advantage.
Methods |
We conducted a repeated cross-sectional analysis of treat-and-release ED visits using 2015 to 2020 data from the Medicare Current Beneficiary Survey. We measured total and out-of-pocket health care spending during 3 time periods: the 30 days prior to the ED visit, the treat-and-release ED visit itself, and the 30 days after the ED visit. Stratified by traditional Medicare or Medicare Advantage status, we determined median total costs and the proportion of costs that were out-of-pocket.
Results |
Among the 5,011 ED visits by those enrolled in traditional Medicare, the weighted median total (and % out-of-pocket) costs were $881.95 (13.3%) for the 30 days prior to the ED visit, $419.70 (10.1%) for the ED visit, and $809.00 (13.8%) for the 30 days after the ED visit. For the 2,595 ED visits by those enrolled in Medicare Advantage, the weighted median total (and % out-of-pocket) costs were $484.92 (24.0%) for the 30 days prior to the ED visit, $216.66 (21.9%) for the ED visit, and $439.13 (22.4%) for the 30 days after the ED visit.
Conclusion |
Older adults insured by Medicare Advantage incur lower total health care costs and face similar overall out-of-pocket expenses in the time period surrounding emergency care. However, a higher proportion of expenses are out-of-pocket compared with those insured by traditional Medicare, providing evidence of greater cost sharing for Medicare Advantage plan enrollees.
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| Supervising editor: Timothy F. Platts-Mills, MD, MSc. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: CJG, SNH, and AKV conceived the study design. WS, CR, and YL performed analyses. All authors iteratively drafted the article, contributed substantially to its revision, and approved the final article. CJG takes responsibility for the paper as a whole. |
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| Data sharing statement: Partial datasets and/or the data dictionary are available upon request to Dr. Cameron Gettel at cameron.gettel@yale.edu to investigators who provide an IRB letter of approval. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Gettel is supported by the National Institute on Aging (NIA) of the National Institutes of Health (U24AG059624, R33AG058926) and the National Academy of Medicine of the National Academy of Sciences under award number SCON-10000824. Dr. Hwang is supported by the National Institute on Aging (R33AG058926, R61AG069822), the John A Hartford Foundation, and the West Health Institute. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript. The content does not represent the views of the United States Department of Veterans Affairs or the United States Government. The authors declare no conflicts of interest. |
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| Presentation information: This work was presented at the 2023 American College of Emergency Physicians Annual Meeting (October 9–12, 2023, Philadelphia, PA). |
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| Please see page XX for the Editor’s Capsule Summary of this article. |
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