Medicare Work-Related Injuries: Underutilization of Workers' Compensation Leads to Higher Out-of-Pocket Costs for Older Adults.

Abstract

Older adults may pay healthcare-related costs for work injuries if Medicare covers claims over workers' compensation (WC). We assessed Medicare enrollee costs after a work-related injury by WC status. We longitudinally analyzed Medicare fee-for-service claims (2016-2019) for Medicare enrollees aged 65 years and older with work-related injuries, estimating WC effects on healthcare use and enrollee costs using difference-in-differences and quantile regression models. WC covered at least one Medicare claim for 16% of the 13,039 enrollees with work-related injuries. Over 90 days, mean Medicare out-of-pocket costs were lower with WC ($447) than without ($778). With WC, enrollees owed $1432 at the 90th percentile compared to $2465 without, an adjusted difference of $600 (95% CL, -767, -432). Although WC covers some costs, Medicare claim billing increases after a work-related injury, often leading to substantial patient expenses.