Complex chronic illness in older sexual and gender minority adults tied to higher Medicare spending and use

Linked Medicare and survey data show chronic condition complexity is a major cost driver, with discrimination patterns that complicate access.

Older sexual and gender minority Medicare beneficiaries with more severe and complex chronic conditions had higher Medicare spending, higher physician spending, and higher odds of being high-cost and using healthcare. Disability and dual eligibility were strongly linked to higher spending. Day-to-day discrimination was tied to more complex chronic conditions but lower Medicare spending.

Quick summary

What the study found: In a sample of 902 sexual and gender minority Medicare beneficiaries, complex chronic illness aligned with higher spending and higher utilization; discrimination related to complexity but also lower spending.
Why it matters: Cost is not only about medical need; it also tracks disability, Medicaid dual eligibility, and social stressors that can shape whether people get care.
What to be careful about: Lower spending alongside higher discrimination may reflect barriers to care rather than better health; the data shown do not establish cause and effect.

What was found

The journal article Chronic conditions and healthcare cost and utilization among underserved Medicare beneficiaries linked survey data from Aging with Pride: National Health, Aging and Sexuality/Gender Study with Medicare Chronic Conditions Warehouse data (n=902).

Average total Medicare spending was $11,671.47 (range $0.00 to $165,650.02). Average physician services spending was $893.46 (range $0.00 to $14,158.42). Ninety-one participants were in the highest-spending 10%.

Participants were grouped by chronic condition severity and complexity: major complex, minor complex, simple chronic illness, and comparatively healthy. Those in major and minor complex groups had significantly higher total Medicare spending than the comparatively healthy group. All three illness groups had higher physician spending than the comparatively healthy group.

Major and minor complex illness increased the odds of being a high-cost beneficiary. Major, minor, and simple chronic illness increased the odds of any healthcare utilization compared with being comparatively healthy.

What it means

The core signal is straightforward: complex multimorbidity tracks with higher cost and more care use. This fits what clinicians see: when conditions stack up, management becomes more intensive, fragmented, and expensive.

The study also flagged disability and dual eligibility as strongly linked to higher Medicare spending. In real-world terms, people with disabling conditions often need more visits, more monitoring, and more services across settings.

One finding deserves special attention: higher day-to-day discrimination was associated with a greater likelihood of chronic condition complexity and lower Medicare spending. That combination can indicate unmet need—people may be sicker but less able or willing to access care.

Where it fits

Minority stress theory is a widely used framework in psychology: chronic exposure to stigma and discrimination can increase stress, which can worsen health over time. This is background context, not a claim about this study’s causal pathway.

The study’s pattern also aligns with a basic health services idea: spending can be suppressed by barriers. Lower spending is not automatically good news if it reflects delayed care, avoidance, or limited access.

How to use it

For health systems serving sexual and gender minority older adults, stratify outreach by chronic condition complexity, disability status, and dual eligibility. These are practical markers for who is most likely to become high-cost and who may need coordinated care.

Pair medical management with discrimination-aware care practices, such as respectful identity documentation and staff training. If discrimination is pushing people away from care, reducing those frictions can be a cost and health intervention.

At the individual care level, treat low utilization cautiously when patients report high day-to-day discrimination. It may signal avoidance, prior negative experiences, or difficulty navigating services.

Limits & what we still don’t know

The results shown are associations from regression models; they do not prove discrimination causes lower spending or that spending changes drive health. The excerpts do not specify all measures used for utilization beyond “any healthcare services,” which limits interpretation.

The sample was mostly non-Hispanic White and predominantly lesbian or gay, and the excerpts do not provide subgroup-specific results for all identities. That means some estimates may not generalize well across the full diversity of sexual and gender minority older adults.

Closing takeaway

This journal article shows that, among sexual and gender minority Medicare beneficiaries, complex chronic illness is tightly linked to higher spending and more use, while discrimination is linked to greater complexity but lower spending. The practical implication is to treat cost patterns as both medical and social signals. If discrimination lowers spending, the priority should be finding the missing care before the patient becomes a crisis cost.

Data in this article is provided by PLOS.

Tagged Adults, Age groups, Allied health care professionals, Behavioral and social aspects of health, Cognitive impairment, Cognitive neurology, Cognitive neuroscience, Cognitive science, Elderly, Health care, Health care providers, Medical personnel, Medical services, Medicare, Neurology, Neuroscience, Physicians, Political science, Population groupings, Professions, Public and occupational health, Public policy, Socioeconomic aspects of health