The CDC has identified specific populations of individuals who are at higher risk for severe illness from COVID-19, including adults aged 65 and older and people of all ages with certain underlying health conditions. To estimate the share of older adults with 1 of these underlying medical conditions, Avalere evaluated the distribution of Medicare fee-for-service (FFS) beneficiaries and associated conditions based on 5 disease categories:

• Autoimmune
• Cancer
• Heart
• Lung
• Metabolic conditions (e.g., diabetes, obesity)

The results indicate that in counties with high prevalence of COVID-19, the majority of adults aged 65 or older are at high risk for serious illness if they contract the virus. In fact, the vast majority of the FFS Medicare beneficiaries nationwide have significant underlying health issues, as 61% of beneficiaries have 1 or more high-risk health conditions. This information has implications for the COVID-19 pandemic as well as future spending in the Medicare program, benefit offerings by Medicare Advantage plans, and the federal budget.

Methodology

Avalere identified FFS beneficiaries with high-risk conditions by analyzing a 20% sample of July 2019 enrollees in Medicare FFS under a Centers for Medicare & Medicaid Services research data use agreement. First, Avalere identified those enrollees who were aged at least 65 as of February 2019, were in traditional Medicare in July 2019, and had 12 months of Part A and B enrollment in 2018. Avalere then analyzed outpatient, inpatient, and physician claims for 2018 dates of service. Finally, we ran the CMS-Hierarchical Condition Category (HCC) model to assign HCCs associated with these 5 diseases and compiled the percentages by county.

To receive Avalere updates, connect with us.

Check out our COVID-19 Intel Center.