What question did this study set out to answer?

This research aims to quantify the additional healthcare spending linked to Medigap coverage and evaluate its distribution across high-value and low-value services among traditional Medicare beneficiaries.

February 19, 2026

Use of High‐ and Low‐Value Care Among Traditional Medicare Beneficiaries With and Without Medigap

Q: What does this research mean for the field?

Medigap coverage is associated with $1062 higher annual Medicare spending among traditional Medicare beneficiaries, but does not consistently promote high- or low-value care. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Points

This research aims to quantify the additional healthcare spending linked to Medigap coverage and evaluate its distribution across high-value and low-value services among traditional Medicare beneficiaries.
Conducted a repeated cross-sectional study using data from the 2013–2021 Medical Expenditure Panel Survey.
Analyzed traditional Medicare beneficiaries with and without Medigap coverage.
Applied inverse probability of treatment weighting (IPTW) to balance observed covariates.
Beneficiaries with Medigap had $1062 higher annual Medicare spending compared to those without Medigap.
Higher spending was largely due to outpatient visits and prescription drugs.
Medigap enrollees had mixed utilization patterns: higher use of some high-value services like colorectal cancer screenings, but lower use of others, such as HbA1c measurement.

Abstract

ABSTRACT Objectives To quantify the additional health care spending associated with Medigap coverage among traditional Medicare (TM) beneficiaries and assess whether this spending is disproportionately allocated to high‐value versus low‐value services. Study Setting and Design We conducted a repeated cross‐sectional study. Data Sources and Analytical Sample We analyzed TM beneficiaries with and without Medigap from the 2013–2021 Medical Expenditure Panel Survey. Inverse probability of treatment weighting (IPTW) was applied to balance observed covariates between TM beneficiaries with and without Medigap. Principal Findings Our sample comprised 16, 619 TM beneficiaries with and without Medigap. After applying IPTW, TM beneficiaries with and without Medigap were well balanced across observed covariates. TM beneficiaries with Medigap had 1062 (346–1779) higher annual Medicare spending than TM beneficiaries without Medigap. Higher spending among Medigap enrollees was primarily driven by outpatient visits (453 148–758) and prescription drugs (572 223–921). However, Medigap coverage was not consistently associated with greater use of either high‐value or low‐value services. Among high‐value services, TM beneficiaries with Medigap had higher utilization of age‐appropriate colorectal cancer screening (1. 4 0. 7–2. 0 percentage points) and influenza vaccination (1. 5 0. 3–2. 6), but lower use of HbA1c measurement (−2. 8 −4. 7, −1. 0). Among low‐value services, TM beneficiaries with Medigap had greater use of prostate cancer screening (6. 4 0. 5–12. 2) and nonsteroidal anti‐inflammatory drug use for hypertension, heart failure, or kidney disease (3. 2 2. 1–4. 4), but lower use of age‐appropriate colorectal cancer screening (−4. 2 −5. 1, −3. 3) and opioid prescriptions for back pain (−6. 2 −8. 3, −4. 2). No significant differences were observed in the remaining services. Conclusions Medigap coverage is associated with higher health care spending among TM beneficiaries, but does not consistently promote high‐ or low‐value care. These findings highlight the need for policy reforms that provide incentives to supplemental insurance plans to encourage evidence‐based service use and discourage spending on unnecessary care.

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Use of High‐ and Low‐Value Care Among Traditional Medicare Beneficiaries With and Without Medigap

Key Points

Abstract

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