Medicare work-related injuries: Underutilization of workers' compensation leads to higher out-of-pocket costs for older adults

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.