OBJECTIVES: The Medicare population accounts for majority of chronic obstructive pulmonary disease (COPD) hospitalizations in United States. Integrated care models and Hospital Readmissions Reduction Program have raised concerns due to lack of best practices. Monitoring of healthcare utilization prior to a COPD hospitalization may identify potential predictors of admission. The objective was to examine healthcare utilization of COPD Medicare beneficiaries 3 months prior to a COPD hospitalization compared to those without. METHODS: Using Medicare Current Beneficiary Survey data set from 2006-2011, beneficiaries were diagnosed with COPD if they had a COPD hospitalization or COPD claim(s) (ICD-9-CM codes). The cohorts of COPD patients with at least one COPD hospitalization and without were followed 3 months prior to a COPD hospitalization and a randomly assigned date, respectively. Cohorts were compared on healthcare utilization (physician visits, inpatient visits, emergency room visits, home health care episodes, skilled nursing facility (SNF) stays, and COPD prescription fills). Covariates assessed were patient characteristics, access to care and socioeconomic factors, comorbidities, COPD severity, and health behaviors.  RESULTS: The sample of 236 beneficiaries with a COPD hospitalization and 1,546 beneficiaries without had 51.7% and 48.8% male beneficiaries, respectively. There was a significant difference (p<0.001) for those with a COPD hospitalization vs. without for median (interquartile range) emergency room visits (1.0 (0.5) vs. 0.0 (0.0), respectively), inpatient visits excluding COPD inpatient visits (0.0 (1.0) vs. 0.0 (0.0), respectively), and COPD prescription fills (0.0 (1.0) vs. 0.0 (0.0), respectively). Those with a COPD hospitalization also differed significantly (p<0.001) compared to those without in access to care and socioeconomic factors, comorbidities, COPD severity, and health behaviors. CONCLUSIONS: Due to higher emergency room visits, inpatient visits, and COPD prescription fills found in the COPD hospitalization cohort, clinicians and health systems should be aware of these potential predictors when assessing practice models.