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. 2021 Mar 23;7(1):e12150.
doi: 10.1002/trc2.12150. eCollection 2021.

Plan switching among Medicare Advantage beneficiaries with Alzheimer's disease and other dementias

David J Meyers  1   2 , Momotazur Rahman  1   2 , Maricruz Rivera-Hernandez  1   2 , Amal N Trivedi  1   2   3 , Vincent Mor  1   2   3
Affiliations

Plan switching among Medicare Advantage beneficiaries with Alzheimer's disease and other dementias

David J Meyers et al. Alzheimers Dement (N Y). .

Abstract

Introduction: Patients with Alzheimer's disease and related dementias (ADRD) face substantial challenges in selecting, and remaining enrolled in, health insurance. Little is known about how patients with ADRD experience the Medicare Advantage (MA) program.

Methods: We used, hospital, outpatient, and post-acute care data to identify MA beneficiaries with and without ADRD in 2014. Multinomial logit models estimated the percentage of people who disenrolled to traditional Medicare (TM) or switched to a different MA plan in 2015.

Results: Among non-dually eligible beneficiaries, 9.0% (95% confidence interval [CI]: 8.0, 9.1) with ADRD disenrolled while 19.7% (95% CI: 19.6, 19.9) switched plans within MA compared to a disenrollment rate of 4.2% (95% CI: 4.2, 4.2) and switching rate of 22.8% (95% CI: 22.9, 22.8) for persons without ADRD.

Discussion: MA enrollees with ADRD tend to disenroll at substantially higher rates than those without ADRD. This may be indicative of their care needs not being met in the program.

Keywords: Medicare; Medicare Advantage; health insurance.

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Conflict of interest statement

Vincent Mor is chair of the scientific advisory board and a consultant at NaviHealth, Inc., as well as former director of PointRight, Inc., where he holds < 1% equity. All other authors have no interests to declare.

Figures

FIGURE 1
FIGURE 1
Adjusted disenrollment and switch rates, by Alzheimer's disease or related dementia (ADRD) diagnosis and dual eligibility status. Adjusted estimates for Medicare Advantage (MA) come from a multinomial logit model with a three‐category outcome of (1) disenroll from MA to traditional Medicare (TM), (2) switch plans within MA, and (3) stay in the same plan (not shown). Models, stratified by ADRD and dual‐eligibility status, adjust for sex; age; race/ethnicity; star rating category; plan premium; plan max out‐of‐pocket payment; plan hierarchical conditions risk score; number of plans in enrollee's county; indicators for increases in plans’ premiums, ratings, or out‐of‐pocket maximums; and indicators that the enrollee was in the highest‐rates, lowest premium, or lowest out‐of‐pocket maximum available in their county of residence. All models used robust standard errors. Beneficiaries who died or moved during the study period are excluded
FIGURE 2
FIGURE 2
Adjusted disenrollment from Medicare Advantage (MA)to traditional Medicare and plan switching within MA for persons with and without Alzheimer's disease and related dementia (ADRD), by type of use. Adjusted estimates for disenrollment and plan switching comes from a multinomial logit model stratified by ADRD and use type, adjusting for sex; age; race/ethnicity; star rating category; plan premium; plan max out‐of‐pocket payment; plan hierarchical conditions risk score; number of plans in enrollee's county; indicators for increases in plans’ premiums, ratings, or out‐of‐pocket maximums; and indicators that the enrollee was in the highest‐rates, lowest premium, or lowest out‐of‐pocket maximum available in their county of residence. This figure includes only non‐dual beneficiaries. No major use indicates that the enrollee did not have any hospital, nursing home, or home health use; however, they may have had outpatient use
FIGURE 3
FIGURE 3
Adjusted disenrollment from Medicare Advantage (MA) to traditional Medicare and plan switching within MA for persons with and without Alzheimer's disease and related dementia, by cognitive function score. This figure only includes beneficiaries who had a nursing home stay, which is necessary for calculating the Cognitive Function Scale (CFS). CFS ranges from 1 to 4, where 4 represents the most cognitively impaired and 1 represents the least. Results are for all non‐dual enrollees adjusted from a multinomial logit model
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References

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