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

Details

• Personal Author:
  Alexander BH ; Erickson DJ ; Jarosek S ; Kim H ; McFalls M ; Ramirez MR ; Ryan A ; Virnig BA
• Description:
  Objective: 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. Methods: We longitudinally analyzed Medicare fee-for-service claims (2016-2019) for age 65+ Medicare enrollees with work-related injuries, estimating WC effects on healthcare use and enrollee costs using difference-in-differences and quantile regression models. Results: 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 $1,432 at the 90th percentile compared to $2,465 without, an adjusted difference of $600 (95% CL -767, -432). Conclusions: While WC covers some costs, Medicare claim billing increases after a work-related injury, often leading to substantial patient expenses. [Description provided by NIOSH]
• Subjects:
  Aging Occupational Health Safety
• Keywords:
  Aging Workforce Author Keywords: Occupational Injuries Costs Cost Shift Difference-in-differences Modeling Health Care Healthcare Expenditures Injuries Longitudinal Study Workers Compensation
• ISSN:
  1076-2752
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Atlanta Region [OSHA] ; Birmingham Region [OSHA] ; California ; Chicago Region [OSHA] ; Florida ; Minnesota ; San Francisco Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• NIOSHTIC Number:
  nn:20070510
• Citation:
  J Occup Environ Med 2025 Feb; :[Epub ahead of print]
• Contact Point Address:
  Matthew Joseph McFalls, Ph.D., Environmental and Occupational Health, UC Irvine Joe C. Wen School of Population & Public Health, 856 Health Sciences Quad University of California, Irvine, Irvine, CA 92697-3957
• Email:
  mmcfalls@uci.edu
• Federal Fiscal Year:
  2025
• Performing Organization:
  University of Minnesota Twin Cities
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of Occupational and Environmental Medicine
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:070534ec83b264b642af115180c9ce4d2fa1eba9f4cfcec91179fcfbab4d3748939b8d4f824fbf9d7547337217e8e95997e4eef4ba77fcff9aeba9f3d0c2925f
• Download URL:
  https://stacks.cdc.gov/view/cdc/208708/cdc_208708_DS1.pdf
• File Type:
  [PDF - 2.21 MB ]