Background/Purpose: MA enrollment has grown rapidly nationwide and now represents a majority of Medicare enrollment in Colorado. As enrollment patterns change, understanding differences in utilization and spending between MA and TM populations is increasingly important for public health planning, health system decision-making, and policy discussions. This study evaluated enrollment growth, utilization, and spending trends among Colorado MA and TM beneficiaries from 2018–2024.
Methods: Researchers conducted a retrospective claims-based analysis using CO APCD data from 2018–2024 among MA and TM beneficiaries. Outcomes included inpatient hospitalizations, emergency department (ED) visits, 30-day readmissions, and per member per month (PMPM) medical spending. Measures were evaluated annually to assess changes over time and compare across coverage types.
Results: Between 2018 and 2024, MA enrollment increased from 353,232 to 584,992 beneficiaries, while TM enrollment declined from 590,970 to 544,954. By 2024, MA represented approximately 52% of the combined MA and TM population. TM beneficiaries consistently demonstrated higher inpatient hospitalization and 30-day readmission rates. Hospitalization rates declined in both populations, from 138 to 111 per 1,000 in MA and 182 to 145 in TM. PMPM medical spending increased overtime in both programs; however, MA spending remained consistently higher despite lower inpatient utilization, suggesting important differences in care delivery, pricing, or service mix.
Implications:
As MA enrollment continues to grow, differences in utilization and spending patterns between MA and TM populations may increasingly influence Medicare spending, access, health care delivery, and future policy discussions across Colorado communities. Findings from this analysis highlight the importance of using statewide claims data to support collaborative public health and policy planning.
