Thirty percent of Medicare spending happens on end-of-life care. How much care and what kind of care do people with Medicare receive? A new study by researchers at the University of Michigan Medical School, published in JAMA Internal Medicine, reveals that the answer likely turns on whether they are enrolled in traditional Medicare or in a Medicare Advantage plan, commercial insurance that offers Medicare benefits generally through an HMO or PPO. The researchers found that people needing more health care opt for traditional Medicare.
People in traditional Medicare are in notably worse health than people in Medicare Advantage plans at the end of life. They are “significantly older” than people in Medicare Advantage plans when they die–1.6 years older on average. More people in traditional Medicare are also widowed or not living with a partner at the time they die.
As compared with people in Medicare Advantage plans, people in traditional Medicare were more inclined to rate their health as poor at the end of their lives, less able to perform activities of daily living (i.e. bathing, toileting, transferring, feeding and dressing), and they had higher rates of dementia.
People in Medicare Advantage plans should have lower health costs at the end of life since they are younger, more independent and have fewer acute care needs than people in traditional Medicare at the end of life. Not surprisingly, they tend to be hospitalized less than people in traditional Medicare at the end of life.
The study posits that Medicare Advantage plans could be better at managing care at the end of life than traditional Medicare since their enrollees have fewer hospitalizations. One might also infer from the data that traditional Medicare does a better job at keeping people alive than Medicare Advantage plans since people in traditional Medicare live longer.
To better understand end of life care and costs, researchers need to look more deeply into the demographic differences in the traditional Medicare and Medicare Advantage populations.
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