Session number: 1004
Abstract title: Enrollment and Utilization in Medicare Among Veterans Turning Age 65
Author(s):
S Wright - VHA Office of Quality and Performance
SL Jackson - Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC)
S Lo - Management Science Group, VHA Office of Policy and Planning
Objectives: An increasing proportion of veterans are approaching their 65th birthday and most will become dually eligible for VA and Medicare services. The purpose of this study was to determine the extent of Medicare enrollment among VA users turning age 65 and ascertain utilization in both VA and Medicare before and after their 65th birthday.
Methods: We established a cohort of all veterans who were users of VA services between 1995 and 1997 (VA users) and who had their 65th birthday in 1997. We linked this cohort with Medicare data files to determine Medicare enrollment status and utilization. Medicare enrollment status after turning age 65 was classified as not-enrolled, age-based enrollee (at age 65), or disability-based entitlement (prior to age 65). VA and Medicare utilization rates per thousand were calculated by enrollment status 2 years before and after a VA user’s 65th birthday.
Results: Of the 80,834 VA users who turned age 65 in 1997, 21,264 (26.3%) were disability-based enrollees. Overall, 93.3% (n=75,401) of VA users enrolled after turning age 65. For the age-based enrollees, inpatient stays increased from 175 to 316 per 1,000 and outpatient visits increased from 7,960 to 13,047 per 1,000; most of the increases were attributable to Medicare. For disability-based enrollees, the primary source of inpatient stays shifted from VA to Medicare setting after age 65 and outpatient visits increased from 12,479 to 21,177 per 1,000 also due to Medicare visits. The total cost of VA and Medicare services in the 2 years before and after age 65 increased from $565 million to $1,045 million.
Conclusions: A high percentage of VA users were already Medicare enrolled based on disability entitlement while most other VA users enrolled after turning age 65. Increases in overall utilization and costs were substantially due to the availability of Medicare services upon turning age 65.
Impact statement: The association between increasing utilization and Medicare availability suggests unmet care may exist among VA users prior to turning age 65. The future of VA health care delivery will be significantly influenced by the increasing availability of Medicare services among disabled and aged veterans.