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Two-Thirds of Seniors Have High-Risk Conditions in Counties with the Most COVID-19 Cases

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Avalere analysis finds that in the top 25 US counties with highest number of COVID-19 diagnoses, two-thirds of Medicare beneficiaries have 1 or more high-risk medical conditions.

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.

Figure 1. Top 25 US Counties by Total Number of COVID-19 Diagnoses and % of Medicare Beneficiaries with High-Risk Diseases
Rank County Name State % of Medicare Beneficiaries with 1 or More High-Risk Diseases % of Medicare Beneficiaries with No High-Risk Diseases
1 Queens County NY 65% 35%
2 Kings County NY 69% 31%
3 Nassau County NY 64% 36%
4 Bronx County NY 64% 36%
5 Suffolk County NY 65% 35%
6 Westchester County NY 62% 38%
7 Cook County IL 61% 39%
8 New York County NY 57% 43%
9 Wayne County MI 68% 32%
10 Bergen County NJ 64% 36%
11 Los Angeles County CA 62% 38%
12 Rockland County NY 65% 35%
13 Hudson County NJ 64% 36%
14 Richmond County NY 66% 34%
15 Essex County NJ 64% 36%
16 Miami-Dade County FL 66% 34%
17 Philadelphia County PA 65% 35%
18 Union County NJ 64% 36%
19 Fairfield County CT 61% 39%
20 Middlesex County NJ 67% 33%
21 Middlesex County MA 63% 37%
22 Passaic County NJ 65% 35%
23 Orleans Parish LA 58% 42%
24 Suffolk County MA 64% 36%
25 Orange County NY 65% 35%

*Data last updated on April 13, 2020, at 11:59 PM PT / April 14, 2020, at 2:59 AM ET

Sources: US Centers for Disease Control and Prevention. Total confirmed coronavirus cases based on data from the Johns Hopkins COVID-19 global cases and USA Facts.

Figure 2. Percent of Medicare FFS Beneficiaries With 1 or More High-Risk Diseases
Figure 2. Percent of Medicare FFS Beneficiaries With 1 or More High-Risk Diseases


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.

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