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Differences in Medicare Service Use in the Last Six Months of Life among Rural and Urban Dual – Eligible Beneficiaries

Individuals with health insurance coverage from both Medicare and Medicaid are generally characterized as dual-eligible (DE)beneficiaries. These beneficiaries include low-income persons age 65 and older and younger adults who qualified for Medicare when they became disabled. Dualeligible beneficiaries are often considered a medically at-risk population. They are institutionalized at higher rates (>16%) than Medicare-only (MO) beneficiaries (2%).  These individuals often report lower health status and have more chronic conditions than Medicare-only beneficiaries.They are of particular interest to policymakers as previous research has shown higher service utilization rates among dual-eligible beneficiaries, particularly among outpatient services, inpatient hospital services, and long-term care.3 These higher utilization rates and subsequent higher costs are of particular concern with end-of-life care. Rural beneficiaries are more likely to be dual eligible than are urban beneficiaries. Given the unique challenges facing the dual eligible population and the more limited health care infrastructure in rural America, the pattern of end of life spending may differ for rural decedents. In this brief, we
compare rural and urban dual-eligible beneficiaries to Medicare-only beneficiaries in their service utilization in the last six months of life. Within rural beneficiaries, we further explore differences associated with race/ethnicity. Details on the persons in the last six months of life included in the study are provided in the next section, followed by separate sections on different types of health services. Technical details regarding the population studied and the analytic approach are provided in an appendix.