Differences in Hospitalizations Between Fee-for-Service and Medicare Advantage Beneficiaries

Previous studies found lower hospitalization rates for enrollees in Medicare Advantage (MA) plans than for beneficiaries with fee-for-service (FFS) coverage. MA enrollment is increasing, especially for those newly eligible for Medicare, but little is known about how service use in FFS or MA differs for new beneficiaries.

To compare differences in rates of hospitalization between MA and FFS.

A retrospective study of hospitalization among FFS and MA respondents to the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey. Differences in hospitalization rates were assessed using multivariable logistic regression models that controlled for patient sociodemographic and health characteristics. Models included an interaction between age and coverage type to determine whether patterns of care were distinct for enrollees recently eligible for Medicare.

In total, 259,335 respondents to the 2013 MCAHPS survey.

In total, 14% of FFS and 12% of MA enrollees had ≥1 hospitalization in the 6 months before survey administration. Models adjusted for enrollee demographics found that MA enrollees had 0.81 the odds of being hospitalized relative to those with FFS coverage (95% confidence interval, 0.78-0.84). Differences between groups were substantially reduced and no longer statistically significant when they were fully adjusted (adjusted odds ratio 1.01, 95% confidence interval, 0.97-1.08). Models with interactions indicated no significant age differences in the MA/FFS hospitalization gap.

Differences in hospital admissions between those with MA and FFS coverage appear to be primarily related to differences in health status.