• Eden Y Bernstein, Christina X Fu, John Z Ayanian, Vilsa E Curto, Timothy S Anderson, and Bruce E Landon.
• Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA. eden.bernstein@cuanschutz.edu.
• J Gen Intern Med. 2025 Feb 10.

BackgroundMedicare Advantage (MA) includes incentives to reduce health care spending and insures over half of Medicare eligible adults. Substance use disorders (SUD) are common in this population.ObjectiveTo compare clinical outcomes between MA and traditional Medicare beneficiaries hospitalized with SUD.DesignRetrospective cohort.PatientsMedicare beneficiaries hospitalized for alcohol withdrawal or opioid overdose from 2016 to 2021.MeasuresPrimary outcomes included mortality and all-cause readmissions within 30 days of discharge. Secondary outcomes included use of SUD medications.ResultsOf 104,833 beneficiaries hospitalized for alcohol withdrawal (mean age 62.1 [SD 11.5] years, 71.8% male) and 75,463 hospitalized for opioid overdose (mean age 64.5 [SD 12.5] years, 40.8% male), 36.4% and 37.3% were enrolled in MA, respectively. Adjusted rates of 30-day mortality were lower in MA for alcohol withdrawal (unadjusted 2.5% in MA vs 2.4% in traditional Medicare; adjusted difference -0.27 pp [95% CI -0.47, -0.08]) but similar for opioid overdose (7.8% in MA vs 7.9% in traditional Medicare; adjusted difference -0.13 pp [-0.54, 0.27]). Rates of 30-day readmissions were lower in MA for both alcohol withdrawal (12.3% in MA vs 13.7% in traditional Medicare; adjusted difference -1.01 pp [95% CI -1.44, -0.59]) and opioid overdose (14.8% in MA vs 17.6% in traditional Medicare; adjusted difference -1.93 pp [95% CI -2.49, -1.37]). Enrollment in MA was associated with lower use of medications for alcohol use disorder (unadjusted 9.6% in MA vs 11.3% in traditional Medicare; adjusted difference -1.66 pp [95% CI -2.72, -0.60]) but higher use of medications for opioid use disorder (unadjusted 4.9% in MA vs 4.2% in traditional Medicare; adjusted difference, 0.82 pp [95% CI 0.08, 1.57]).ConclusionsCompared to traditional Medicare, MA was associated with modestly lower 30-day mortality after alcohol withdrawal, lower 30-day readmission rates after alcohol withdrawal and opioid overdose hospitalizations, and mixed findings on medication use.© 2025. The Author(s), under exclusive licence to Society of General Internal Medicine.

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