Are Medicaid and Medicare Patients Treated Equally?

2024-14 | April 17, 2024

Revised May 2024

We examine whether Medicaid recipients receive the same health care services as those on Medicare. We track the services provided to the same individual as they age into Medicare from Medicaid at age 65, becoming dual enrolled. Cost sharing remains negligible across the insurance switch, implying that observed changes in care utilization reflects supply-side factors. Utilization increases by about 20 percent upon switching to Medicare, across a range of categories and treatments including high-value care. We find that 60 to 90 percent of the increase in office visits is explained by physicians averse to accepting new Medicaid patients. Geographic variation in our estimates shows that the average increase in utilization is larger in those states with lower Medicaid acceptance rates and higher Medicare acceptance rates. By contrast, we find relatively small increases in care from existing provider-patient relationships with Medicaid providers. This analysis indicates that Medicaid’s smaller provider network plays a large role in limiting utilization.

Suggested citation:

Ackley, Calvin, Abe Dunn, Eli Liebman, and Adam Hale Shapiro. 2024. “Are Medicaid and Medicare Patients Treated Equally?” Federal Reserve Bank of San Francisco Working Paper 2024-14.

About the Authors
Calvin Ackley, Bureau of Economic Analysis
Abe Dunn, Bureau of Economic Analysis
Eli Liebman, University of Georgia
Adam Shapiro is a vice president in the Economic Research Department of the Federal Reserve Bank of San Francisco. Learn more about Adam Shapiro