Medicare Spending by Functional Impairment and Chronic Conditions


Per capita Medicare spending is higher for seniors with chronic conditions and functional impairment than for seniors with chronic conditions alone. Seniors with chronic conditions and functional impairment require acute care and long-term services and supports (LTSS) from systems that are fragmented. The lack of coordination between acute care and LTSS may contribute to the unnecessary utilization of health services and higher spending on this population.

Date Updated: 07/12/2012

This analysis is based on the 2006 Medicare Current Beneficiary Survey (MCBS) Cost and Use file, an annual, longitudinal survey of a representative sample of all Medicare enrollees. The MCBS collects information on Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), health services utilization, and health spending.

  • Adding 10 mandatory LTSS-related questions to Health Risk Assessments (HRA) – administered by health plans to assess for individuals’ needs and risk;
  • Requiring CMC plans to provide unlimited non-emergency transportation;
  • Extending the continuity of care provisions for an individual to keep an out-of-network doctor when transitioning to CMC from six to 12 months; and
  • Revising the CMC beneficiary toolkit to make it easier to understand