Comparison of Health Care Utilization by Medicare Advantage and Traditional Medicare Beneficiaries with Complex Care Needs

Dana Drzayich Antol
Richard Schwartz
Ariel Caplan
Adrianne Casebeer
C. Jo Erwin
William H. Shrank
Brian W. Powers
Peer-Reviewed Article
October 2022


Medicare beneficiaries with complex needs who were enrolled in Medicare Advantage (MA) had lower rates of acute care utilization than those enrolled in traditional Medicare.


As MA enrollment grows, MA plans are serving increased numbers of members with complex health needs. These plans have levers that can potentially be designed to address the fragmentation of care for this population, such as care management, supplemental benefits, and value-based contracting. This cross-sectional study compared individuals with complex care needs (including cohorts of frail elderly and people with major and minor complex chronic conditions) who were enrolled in MA to those enrolled in traditional Medicare to understand whether enrollment in MA plans impacts beneficiary outcomes. 


Individuals with complex care needs enrolled in MA had lower acute care utilization than those enrolled in traditional Medicare, as measured by hospital stays, emergency department visits, and 30-day readmissions. The frail elderly cohort had approximately nine percent fewer hospitalizations than the traditional Medicare group, and the major complex chronic cohort had twelve percent fewer hospital stays. This study also found that MA beneficiaries enrolled in more advanced value-based payment models as well as those in HMO plans had a larger decrease in utilization as compared to those in less advanced models and those in PPO plans.


The managed care functions of MA plans may support improved care coordination for beneficiaries with complex care needs, as measured by reduced acute care utilization.

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