New Study Finds Medicare Advantage Leads to 10% Fewer Avoidable Hospitalizations Than Traditional Medicare

The likelihood of an avoidable hospitalization is 10% lower for Medicare Advantage beneficiaries than for traditional fee-for-service Medicare enrollees.


Contact: Adjoa Adofo, 202-735-0037

WASHINGTON, DC (March 15, 2016) – A new research study released today by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care on behalf of the Better Medicare Alliance (BMA) found that the likelihood of an avoidable hospitalization is 10% lower for Medicare Advantage beneficiaries than for traditional fee-for-service Medicare enrollees.

The study analyzed data from the Healthcare Cost and Utilization Project for twelve states to compare hospitalization rates for Medicare Advantage and traditional Medicare beneficiaries. The analysis focuses on three types of inpatient care including avoidable hospitalizations that could be prevented by better outpatient care; marker condition hospitalizations, which are for conditions that would not be prevented by better outpatient care; and referral-sensitive hospitalizations, which are designed to prevent worse outcomes.

The study found that Medicare Advantage enrollees were less likely than traditional Medicare beneficiaries to have an avoidable hospitalization, a finding that is consistent with other research results.  The study also showed a greater number of referral-sensitive hospitalization rates — which are a marker for better outpatient care — for Medicare Advantage patients.

“These findings show Medicare Advantage enrollees are significantly less likely to experience avoidable hospitalization rates than those with traditional Medicare despite age, gender, race, or even severity of illness,” said Allyson Y. Schwartz, President and CEO of BMA. “Under Medicare Advantage, the emphasis on primary care, care coordination, disease management, and supportive services pays real dividends. In the effort to reform Medicare, Medicare Advantage is moving us in the right direction.”

The study also found a “spill-over” effect occurred among traditional Medicare patients who lived in counties with a greater number of beneficiaries enrolled in Medicare Advantage plans. As Medicare Advantage penetration rates increase, avoidable hospitalizations—compared with expected hospitalizations—decrease for both Medicare Advantage and traditional Medicare beneficiaries.

“We’re in a period of health care reform and we’re looking at alternative ways to organize care and ways to pay for that care,” said Stephen Petterson, PhD, Research Director, Robert Graham Center. “Medicare Advantage plans have historically promised to control costs without jeopardizing quality of care by emphasizing preventive services and promoting primary care. Now there’s growing evidence, including the findings in our report, showing that relative to Medicare fee-for-service, Medicare Advantage reduces avoidable hospitalization and possibly lowers costs.”

Click to view full report here.


Better Medicare Alliance | The Better Medicare Alliance (BMA) is the leading coalition of nurses, doctors, health plans, employers, aging service agencies, advocates, retiree organizations, and beneficiaries supporting Medicare Advantage. Medicare Advantage offers quality, affordability and simplicity, with enhanced benefits to more than 17 million Medicare beneficiaries across America. BMA works to ensure the sustainability and stability of Medicare Advantage through information, research, education, and united support among stakeholders to strengthen this important coverage for seniors and people with disabilities. For more information please visit

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