Postacute COVID-19 Symptoms and Health Care Utilization and Spending Among Traditional Medicare Beneficiaries.

Importance: Postacute sequelae of SARS-CoV-2 infection include fatigue, respiratory symptoms, and cognitive dysfunction. However, the extent to which these symptoms contribute to increased health care utilization and spending among Medicare beneficiaries remains unclear. Objective: To quantify differences in postacute symptoms and health care utilization and spending between traditional Medicare beneficiaries with COVID-19 and matched control beneficiaries without COVID-19. Design, Setting, and Participants: This cohort study used traditional Medicare claims from February 2020 through November 2022. Beneficiaries with a documented COVID-19 diagnosis were matched 1:5 to beneficiaries without COVID-19 based on demographic and clinical characteristics. Four variant-defined cohorts (original strain and Alpha, Delta, and Omicron variants) were analyzed. Follow-up extended through 40 weeks after diagnosis. Data were analyzed from February 2020 to November 2022. Main Outcomes and Measures: Diagnosis of 21 postacute COVID-19 symptoms, all-cause health care utilization, and Medicare spending were compared between those with COVID-19 and matched control beneficiaries using logistic and linear regression models adjusted for demographic and clinical covariates. Results: The cohort study included 937 077 Medicare beneficiaries with COVID-19 and 4 808 573 matched control beneficiaries without COVID-19 (3 109 789 females [54.1%]), with most beneficiaries (4 880 497 [84.9%]) aged 65 years or older. During the acute phase of infection (diagnosis week), beneficiaries with COVID-19 were 41.71 (95% CI, 41.62-41.91) percentage points more likely to receive at least 1 postacute symptom diagnosis than control beneficiaries. This difference declined to 5.22 (95% CI, 5.11-5.32) percentage points during weeks 1 to 12 and to 1.94 (95% CI, 1.81-2.05) percentage points during weeks 13 to 40. Medicare spending was $7933.13 higher (95% CI, $7904.12-$7962.14) in the acute phase, decreasing to $232.31 (95% CI, $230.11-$234.14) per week in weeks 1 to 12 and to $28.21 (95% CI, $27.11-$30.13) per week in weeks 13 to 40. Differences in health care utilization followed a similar pattern, decreasing to 0.05 (95% CI, 0.05-0.06) visits per week in weeks 1 to 12 and to 0.03 (95% CI, 0.02-0.03) visits per week in weeks 13 to 40. Conclusions and Relevance: In this cohort study of traditional Medicare beneficiaries across major COVID-19 variants, postacute symptom diagnoses and health care utilization and spending were substantially higher in the acute phase of COVID-19 but diminished over time, approaching levels observed in matched control beneficiaries without COVID-19 by 3 months after infection. These findings suggest limited long-term excess health care utilization or spending attributable to COVID-19 infection among older adults.