Effect of new Medicare enrollment on health, healthcare utilization, and cost: A scoping review

Abstract

Background More than three million Americans turn 65 each year and newly enroll in Medicare, making this one of the most common insurance transitions. Non‐Medicare insurance transitions are associated with changes in health, healthcare utilization and costs. In addition, older Americans have higher morbidity, mortality, healthcare utilization, and healthcare costs than the general population. However, the effect of new Medicare enrollment on these outcomes is unclear. Design We conducted a scoping review to rigorously identify the scope of evidence on the association between new Medicare enrollment and health, healthcare utilization and costs. Setting We included English‐language, peer‐reviewed, studies cataloged in Medline (PubMed) and EconLit from 1998 to 2018. Participants Individuals newly enrolling in Medicare. Measurements We measured health (e.g., self‐reported health), healthcare utilization (e.g., provider visits, preventive care, and hospitalizations) and costs (e.g., patient out‐of‐pocket and health plan spending). Results We screened 5265 articles and included 20 articles. New Medicare enrollment was found to increase self‐reported health and healthcare utilization overall, as well as reduce disparities across racial and socioeconomic strata. Provider visits, preventive care and hospitalizations all increased. However, patient out‐of‐pocket spending decreased, and health plan spending also decreased, when Medicare's lower prices were accounted for. Few studies compared outcomes among new Medicare Advantage enrollees with new Medicare fee‐for‐service enrollees. None of the studies specifically evaluated the effect of new Medicare enrollment on adults with multiple chronic conditions. Conclusion New Medicare enrollment improves access overall and reduces access disparities. However, the impact of new Medicare enrollment among subgroups defined by insurance coverage type and number of chronic conditions is less clear. Future work should also evaluate the mechanism for increases in hospitalizations.

Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

“…Despite having relatively lower age-adjusted rates of cytology/HPV testing, Hispanic and non-Hispanic Black populations have maintained higher overall age-adjusted rates of colposcopy and cervical procedures. This could represent increased use of health care services after becoming Medicare eligible and an associated detection of previously undetected abnormalities, especially as older Hispanic and non-Hispanic Black populations are much more likely to be overdue for cervical cancer screening . Future studies investigating these populations on a more granular level could provide insight into the cervical cancer incidence disparities seen in older individuals by racial and ethnic groups …”

Bladder and Kidney Cancer Diagnosis and Survival Increase With Medicare Eligibility at Age 65

“…Medicare eligibility has previously been associated with increased health care utilization in terms of hospitalizations, office visits, and age-appropriate preventive care. 2,6,[19][20][21] Increased preventive care with Medicare eligibility may play a role in driving the observed increase in bladder and kidney cancer diagnosis and survival due to the incidental detection of microhematuria on urinalysis, a common component of routine labs. Medicare-eligible individuals have previously been found to undergo more frequent screening for colorectal, breast, and prostate cancers.…”

“…Americans with little to no health care coverage before enrolling in Medicare have previously been demonstrated to increase their utilization of health care services, including catching up with age-appropriate screenings that had been missed in the years prior. [4][5][6][7][8] Many of these screenings are aimed at detecting cancer. For the underinsured, routine screening or evaluation of cancer symptoms may have been delayed until the onset of Medicare eligibility.…”

Factors associated with persistent multiyear frequent emergency department use

“…We used data from 2011 as a 1-year washout period to exclude all temporary ED users identified in the baseline year who had an ED visit in 2011. For each state, only ED visits by in-state residents aged 18–59 in 2012 were included to avoid new enrolment to Medicare (the federal health insurance program for those who are 65 or older) at the age of 65 later in the study period, as having Medicare has been shown to affect healthcare utilisation 18 21. Individuals who died in the baseline year were also excluded.…”