DataPoint: COVID-19 Prevalence Among Medicare Beneficiaries
Based on Medicare claims and encounter data provided by the Centers for Medicare and Medicaid Services (CMS) as of June 11, 2020, 326,674 total COVID-19 cases were reported from Jan. 1st to May 16, 2020. The data reported is a snapshot of Medicare Fee-for-Service (FFS) claims data, Medicare Advantage (MA) encounter data, and Medicare enrollment based on COVID-19 cases used on ICD-10 diagnosis codes. As of April 2020, over 62.3 million Americans were enrolled in Medicare, 60 percent in FFS and 40 percent in MA plans. Nationwide, there were 518 cases per 100K enrollees. In rural communities, there were 210 cases per 100K, while urban areas had 597 cases per 100K.
COVID-19 cases were much more likely among dual eligible beneficiaries (1,406 cases per 100K) than among Medicare-only (325 cases per 100K). Cases were most common among the oldest Medicare beneficiaries. For beneficiaries over age 85, there were 1,140 cases per 100K, which was more than twice as prevalent as the overall Medicare community. Dual eligible Medicare beneficiaries over age 85 (3,353 cases per 100K) had nearly five times as many COVID-19 cases as Medicare-only beneficiaries in the same age bracket (688 cases per 100K).
Total COVID-19 hospitalizations reported on Jan. 1st to May 16, 2020 Medicare claims and encounter data exceeded 100K, with 74 percent coming from FFS claims. Nationwide, 175 COVID-19-related hospitalizations occurred per 100K enrollees. In rural communities, there were 57 hospitalizations per 100K, while 205 hospitalizations per 100K occurred in urban areas. Approximately 28 percent of Medicare beneficiaries hospitalized for COVID-19 died, while 27 percent were discharged to home. The next most likely hospitalization discharge destination was a skilled nursing facility (SNF) (21 percent). A length of stay of one to seven days occurred in 50 percent of Medicare COVID-19 hospitalizations. In addition, Medicare FFS COVID-19 hospitalization claims cost $1.9 billion, an average payment of $23,094 per FFS COVID-19 hospitalization.
To view the Medicare COVID-19 Data Snapshot, which is about people with Medicare who are diagnosed with COVID-19, click here.
Contact: Ken Allison, kallison@leadingageny.org, 518-867-8820