Use of High‐ and Low‐Value Care Among Traditional Medicare Beneficiaries With and Without Medigap
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To quantify the additional health care spending associated with Medigap coverage among traditional Medicare (TM) beneficiaries and assess whether this spending is disproportionately allocated to high-value versus low-value services. STUDY SETTING AND DESIGN: We conducted a repeated cross-sectional study. DATA SOURCES AND ANALYTICAL SAMPLE: We analyzed TM beneficiaries with and without Medigap from the 2013-2021 Medical Expenditure Panel Survey. Inverse probability of treatment weighting (IPTW) was applied to balance observed covariates between TM beneficiaries with and without Medigap. PRINCIPAL FINDINGS: Our sample comprised 16,619 TM beneficiaries with and without Medigap. After applying IPTW, TM beneficiaries with and without Medigap were well balanced across observed covariates. TM beneficiaries with Medigap had $1062 (346-1779) higher annual Medicare spending than TM beneficiaries without Medigap. Higher spending among Medigap enrollees was primarily driven by outpatient visits ($453 [148-758]) and prescription drugs ($572 [223-921]). However, Medigap coverage was not consistently associated with greater use of either high-value or low-value services. Among high-value services, TM beneficiaries with Medigap had higher utilization of age-appropriate colorectal cancer screening (1.4 [0.7-2.0] percentage points) and influenza vaccination (1.5 [0.3-2.6]), but lower use of HbA1c measurement (-2.8 [-4.7, -1.0]). Among low-value services, TM beneficiaries with Medigap had greater use of prostate cancer screening (6.4 [0.5-12.2]) and nonsteroidal anti-inflammatory drug use for hypertension, heart failure, or kidney disease (3.2 [2.1-4.4]), but lower use of age-appropriate colorectal cancer screening (-4.2 [-5.1, -3.3]) and opioid prescriptions for back pain (-6.2 [-8.3, -4.2]). No significant differences were observed in the remaining services. CONCLUSIONS: Medigap coverage is associated with higher health care spending among TM beneficiaries, but does not consistently promote high- or low-value care. These findings highlight the need for policy reforms that provide incentives to supplemental insurance plans to encourage evidence-based service use and discourage spending on unnecessary care.
Source: Health Services Research
Authors: Sungchul Park, A. Mark Fendrick
Institutions: Korea University, University of Michigan, Michigan Medicine
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7129205896