Utilization and Efficiency Under Medicare Advantage vs. Medicare Fee-for-Service

This white paper documents the differences in healthcare utilization and efficiency between Medicare Advantage (MA) and Medicare Fee-for-Service (FFS) coverage for comparable populations. The study leverages Inovalon’s Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry dataset, which includes a nationally representative sample of beneficiaries who turned age 65 between 2015 and 2019. The analysis focuses on the two years following Medicare enrollment, comparing healthcare resource utilization, expenditures, and service-specific metrics. Findings indicate that MA beneficiaries experience significantly lower inpatient stays and emergency doctor visits compared to FFS enrollees, with overall healthcare costs being 12% lower under MA. The research also highlights that FFS has higher utilization rates compared to standard commercial coverage, suggesting potential shortcomings in FFS program design. The insights aim to assist health plans and policymakers in optimizing performance and improving healthcare delivery under MA and FFS frameworks.