Effect of coverage gap on healthcare utilization among Medicare beneficiaries with chronic obstructive pulmonary disorder

Sujit S. Sansgiry, Archita Bhansali, Omar Serna, Michele Kamdar, Marc Fleming, Susan Abughosh, Richard Hiraiwa Stanford

Research output: Contribution to journalArticle


Objective: To evaluate the association between the Medicare coverage gap with hospitalization, emergency room (ER) visits, and time to hospitalization in chronic obstructive pulmonary disease (COPD) patients. Methods: Retrospective cohort study using data from a Medicare Advantage (MA) plan. Patients with ≥1 claim for COPD at baseline, ≥65 years, continuous 24-months enrollment and without any cancer/end stage renal disease diagnosis were eligible. Patients not reaching the coverage gap (no coverage gap) were matched and compared to those reaching the coverage gap and those reaching catastrophic coverage in separate analyses. Chi-square tests and Cox proportional hazards model were used to compare outcomes across matched cohorts. Results: In total, 3142 COPD patients were identified (79% no coverage gap, 10% coverage gap, and 11% catastrophic coverage). Compared to the no coverage gap group, a larger number of beneficiaries in the coverage gap group had ≥1 hospitalization (26% vs 32%, p <.05), ≥ 1 ER visits (43% vs 49%, p <.05), and ≥1 hospitalization/ER (total visit) (47% vs 54%, p <.05), respectively. Compared to the no coverage gap group, a greater number of beneficiaries in catastrophic coverage had ≥1 ER visit (45% vs 53%, p <.05) or ≥1 total visits (48% vs 56%, p <.05), respectively. Time to hospitalization was shorter among those entering the coverage gap as compared to the no coverage gap [Hazards Ratio (HR) = 1.5; p =.040]. Conclusions: COPD patients entering the coverage gap and catastrophic coverage were associated with increased utilization of healthcare services. Entering the coverage gap was also associated with shorter time to hospitalization as compared to the no coverage gap.

Original languageEnglish
Pages (from-to)321-328
Number of pages8
JournalCurrent Medical Research and Opinion
Issue number2
StatePublished - 1 Feb 2019



  • Chronic obstructive pulmonary disease
  • Coverage gap
  • Healthcare utilization
  • Medicare advantage plan

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