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Medicare fee-for-service utilization decreased dramatically during the COVID-19 pandemic

Utilization among whites decreased more than among Black or Hispanic populations, but the largest utilization decreases were among Asians.

Jeff Lagasse, Associate Editor

Healthcare utilization among Medicare fee-for-service beneficiaries decreased dramatically during the spring of 2020 compared to the spring of 2019, finds a new Avalere analysis. 

This speaks to the impact that the COVID-19 pandemic has had, with utilization decreasing during the first three months of the public health emergency (March, April and May) and showing a dramatic decline in April in particular. In that month, there was a 51% reduction in outpatient claims and a 42% reduction in inpatient claims in 2020, compared to 2019.

Inpatient claims started climbing back up in June 2020, but only slightly, at 3%. Outpatient claims dipped a further 1% during that month.

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In the spring of 2020, lockdowns were imposed across the U.S. in order to prevent the spread of COVID-19. During these lockdowns, healthcare facilities were closed for most care, with the exception of acute and emergency services.

Avalere assessed Medicare FFS claims volume for hospital inpatient, hospital outpatient, and professional/physician services during the first six months of 2020, as compared to the first six months of 2019.

It also examined healthcare utilization changes between the first half of 2019 and 2020 by race, and found that utilization among the white Medicare population decreased more than among the Black or Hispanic populations. But the largest utilization decreases were among Asian beneficiaries, who account for 2% of the overall Medicare FFS population (White Medicare beneficiaries constitute 81%, Black Medicare beneficiaries 9% and Hispanic Medicare beneficiaries 2%).

In April 2020, which showed the most dramatic declines, utilization among Asians dipped 47%. The White population showed a 45% decrease, while the decrease for Hispanics and Blacks was 34% and 32%, respectively. 

The analysis also found a larger decrease in claims for non-duals than for the dual-eligible population (Medicare beneficiaries also eligible for Medicaid). While duals and non-duals looked similar in terms of their utilization rates in January and February of 2020 compared to the same months of 2019, the groups deviated in the spring. Dual-eligible beneficiaries had 28 fewer claims in April of 2020 compared to April of 2019, while the number of claims per non-dual eligible Medicare beneficiaries fell 48% in April 2020 compared to April 2019.

The impact of delayed or avoided care on the health status of Medicare beneficiaries will likely be further examined over the following months and years, as there could be lasting effects, even as the pandemic recedes. Plus, decrease in service utilization could indicate that people missed out on preventive care and postponed care they may have needed to receive, which contributes to compounding concerns in management of chronic and acute care – leading to pent-up demand in future months, in addition to potential healthcare costs associated with gaps in care.


The COVID-19 pandemic has had a profound effect on how, and whether, people seek care. A survey published in January found that two out of five individuals delayed or missed medical care in the early phase of the pandemic, from March through mid-July 2020.

In all, 41% of respondents delayed or missed medical care during that time. Among the 1,055 people who reported needing medical care, 29% indicated fear of transmission of COVID-19 as the main reason. Seven percent reported financial concerns as the main reason for delaying or missing care.

Among the 1,337 respondents, 29% reported missing a preventive care visit, 26% reported missing an outpatient general medical appointment, 8% reported missing one or more doses of a prescription medication, 8% reported missing an outpatient mental health appointment, 6% reported missing an elective surgery, and 3% reported not receiving healthcare for a new severe mental or physical health issue.

Among the 1,055 individuals who reported needing medical care from March to mid-July 2020, more than half, 52%, reported missing care. Among those, 58% who had a scheduled preventive care appointment missed the appointment, and 60% with a scheduled elective surgical procedure skipped the procedure. About half of respondents with a new severe mental health or physical health issue that started after the start of the pandemic reported not seeking care for a new health issue.

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