Postacute COVID-19 Symptoms and Health Care Utilization and Spending Among Traditional Medicare Beneficiaries

Postacute sequelae of SARS-CoV-2 infection include fatigue, respiratory symptoms, and cognitive dysfunction. However, the extent to which these symptoms contribute to increased health care utilization and spending among Medicare beneficiaries remains unclear.

To quantify differences in postacute symptoms and health care utilization and spending between traditional Medicare beneficiaries with COVID-19 and matched control beneficiaries without COVID-19.

This cohort study used traditional Medicare claims from February 2020 through November 2022. Beneficiaries with a documented COVID-19 diagnosis were matched 1:5 to beneficiaries without COVID-19 based on demographic and clinical characteristics. Four variant-defined cohorts (original strain and Alpha, Delta, and Omicron variants) were analyzed. Follow-up extended through 40 weeks after diagnosis. Data were analyzed from February 2020 to November 2022.

Diagnosis of 21 postacute COVID-19 symptoms, all-cause health care utilization, and Medicare spending were compared between those with COVID-19 and matched control beneficiaries using logistic and linear regression models adjusted for demographic and clinical covariates.

The cohort study included 937 077 Medicare beneficiaries with COVID-19 and 4 808 573 matched control beneficiaries without COVID-19 (3 109 789 females [54.1%]), with most beneficiaries (4 880 497 [84.9%]) aged 65 years or older. During the acute phase of infection (diagnosis week), beneficiaries with COVID-19 were 41.71 (95% CI, 41.62-41.91) percentage points more likely to receive at least 1 postacute symptom diagnosis than control beneficiaries. This difference declined to 5.22 (95% CI, 5.11-5.32) percentage points during weeks 1 to 12 and to 1.94 (95% CI, 1.81-2.05) percentage points during weeks 13 to 40. Medicare spending was $7933.13 higher (95% CI, $7904.12-$7962.14) in the acute phase, decreasing to $232.31 (95% CI, $230.11-$234.14) per week in weeks 1 to 12 and to $28.21 (95% CI, $27.11-$30.13) per week in weeks 13 to 40. Differences in health care utilization followed a similar pattern, decreasing to 0.05 (95% CI, 0.05-0.06) visits per week in weeks 1 to 12 and to 0.03 (95% CI, 0.02-0.03) visits per week in weeks 13 to 40.

In this cohort study of traditional Medicare beneficiaries across major COVID-19 variants, postacute symptom diagnoses and health care utilization and spending were substantially higher in the acute phase of COVID-19 but diminished over time, approaching levels observed in matched control beneficiaries without COVID-19 by 3 months after infection. These findings suggest limited long-term excess health care utilization or spending attributable to COVID-19 infection among older adults.