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Medicare Advantage vs. Medicare Fee-for-Service Longitudinal Site of Death Study

A recent study found that people who are continuously enrolled in Medicare Advantage (MA) are less likely to die in a hospital than people continuously enrolled in Medicare fee-for-service. Researchers analyzed differences in the location of death (e.g., hospital, home) and found that:

“Hospice care is carved out of Medicare Advantage, so health plans are not responsible for enrollees’ costs once they enroll in hospice care.”

This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (MA) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study (n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008–2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting).

Logistic regression estimated the odds of dying in hospital for those continuously enrolled in MA from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in MA contracts may reduce the odds of dying in hospital.

The study was conducted using data on Medicare beneficiaries from the Health and Retirement Study who died between 2008 and 2010.

Analysis

Financial incentives in Medicare Advantage may be one of the reasons why the odds of dying in a hospital are lower for enrollees. Hospice care is carved out of Medicare Advantage, so health plans are not responsible for enrollees’ costs once they enroll in hospice care. Once beneficiaries are admitted into hospice care, Medicare Part A is responsible for the costs. This policy may encourage health plans to promote hospice care.

Source: Elizabeth Edmiston Chen and Edward Alan Miller, Research on Aging, “A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare,” May 2016.