JAMA Netw Open. 2025 Oct 1;8(10):e2540347. doi: 10.1001/jamanetworkopen.2025.40347.
ABSTRACT
IMPORTANCE: Postacute care expenditures exceed $57.3 billion annually for traditional Medicare (TM) and drive regional spending variation. Medicare Advantage (MA) plans, with financial incentives to optimize postacute care, offer a compelling alternative. With more than half of Medicare beneficiaries now enrolled in MA, understanding postacute care use and outcomes across these groups is increasingly critical for policy and practice.
OBJECTIVE: To analyze the association of MA enrollment with postacute care use and patient outcomes compared with TM.
DESIGN, SETTING, AND PARTICIPANTS: This cross-temporal cohort study using a difference-in-differences approach matched 2021 MA beneficiaries to 2015 TM beneficiaries with a high propensity of enrolling in MA. The study included Medicare beneficiaries aged 66 years or older discharged alive from acute care in 2015 or 2021 and subsequently admitted to a skilled nursing facility (SNF) or to home health care. The data were analyzed between April 1, 2023, and August 28, 2025.
EXPOSURE: Enrollment in MA plans.
MAIN OUTCOMES AND MEASURES: The main outcomes were the proportion of beneficiaries discharged to an SNF or home health, length of stay in an SNF or home health, 100-day hospital readmission and mortality rates, total days in the community, and changes in functional status. Difference-in-differences analyses were conducted using linear probability models for binary outcomes, and linear regression models were used for continuous outcomes. Doubly robust models included the same covariates as the propensity score models to adjust for residual imbalances in the matching.
RESULTS: The study included 7 294 038 patients hospitalized in 2015 and 2021, with 2 687 009 (36.8%) enrolled in MA at some point. The final analytic sample included 1 081 103 MA beneficiaries enrolled in 2021 matched to 221 119 MA beneficiaries enrolled in 2015 (n = 1 302 222; mean [SD] age, 77.3 [7.9] years; 54.6% female) and 1 625 316 TM beneficiaries enrolled in 2021 matched to 534 607 TM beneficiaries enrolled in 2015 (n = 2 159 923; mean [SD] age, 78.4 [8.2] years; 53.9% female). The MA beneficiaries exhibited greater reductions in postacute care use compared with TM beneficiaries, including 6.3 fewer days in SNFs (95% CI, -6.8 to -5.8 days) and 3.6 fewer days in home health (95% CI, -4.3 to -2.9 days). Medicare Advantage enrollees also experienced a 1.5-percentage point lower probability of readmission (95% CI, -1.8 to -1.2 percentage points) and spent more time in the community in the first 100 days after hospital discharge (difference, 1.9 days; 95% CI, 1.7-2.2 days) than TM beneficiaries. Medicare Advantage beneficiaries also experienced a slightly lower mortality (difference, -0.3 percentage points; 95% CI, -0.6 to -0.1 percentage points) compared with TM beneficiaries, as well as modest functional gains (difference in 30-day activities of daily living improvement, 2.5 percentage points; 95% CI, 1.7-3.4 percentage points).
CONCLUSIONS AND RELEVANCE: These findings suggest that reductions in postacute care in comparable MA and TM beneficiaries were not associated with worse outcomes.
PMID:41160023 | DOI:10.1001/jamanetworkopen.2025.40347
