Estimates of diagnosed dementia prevalence and incidence among diverse beneficiaries in traditional Medicare and Medicare Advantage

Abstract

Approximately half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), a private plan alternative to traditional Medicare (TM). Yet little is known about diagnosed dementia rates among MA enrollees, limiting population estimates. All (100%) claims of Medicare beneficiaries using encounter data for MA and claims for TM for the years 2015 to 2018 were used to quantify diagnosed dementia prevalence and incidence rates in MA, compare rates to TM, and provide estimates for the entire Medicare population and for different racial/ethnic populations. In 2017, dementia incidence and prevalence among MA beneficiaries were 2.54% (95% confidence interval [CI]: 2.53 to 2.55) and 7.04% (95% CI: 7.03 to 7.06). Comparison to TM adjusted for sociodemographic and health differences among beneficiaries in MA and TM; the prevalence of diagnosed dementia among beneficiaries in MA was lower (7.1%; 95% CI: 7.12 to 7.13) than in TM (8.7%; 95% CI: 8.71 to 8.72). The diagnosed dementia incidence rate was also lower in MA (2.50%; 95% CI: 2.50 to 2.50) compared to TM (2.99%; 95% CI: 2.99 to 2.99). There were lower rates in MA compared to TM for men and women and White, Black, Hispanic, Asian, American Indian/Alaska Native persons. Diagnosed dementia prevalence and incidence for the entire Medicare population was 7.9% (95% CI: 7.91 to 7.93) and 2.8% (95% CI: 2.77 to 2.78). Lower diagnosed dementia rates in MA compared to TM may exacerbate racial/ethnic disparities in diagnosed dementia. Rates tracked over time will provide understanding of the impact on dementia diagnosis of 2020 MA risk adjustment for dementia.

Keywords: Alzheimer's disease; Medicare; Medicare Advantage; dementia; diagnosis.

FIGURE 1

(A) Dementia prevalence in traditional Medicare (TM) and Medicare Advantage (MA) in 2016 and 2017. (B) Dementia prevalence by sex and race/ethnicity in TM and MA in 2017.

FIGURE 2

(A) Dementia incidence in traditional Medicare (TM) and Medicare Advantage (MA) in 2016 and 2017. (B) Dementia incidence by sex and race/ethnicity in TM and MA in 2017.

FIGURE A1

Dementia Prevalence in MA Beneficiaries from Encounter and CDM data. CDM are Medicare Advantage beneficiaries in the CDM data. MAE are estimates in the MA Encounter data from the same large insurance company represented in the CDM data for year 2016.

FIGURE A2

Dementia Incidence in MA Beneficiaries from Encounter and CDM data. CDM are Medicare Advantage beneficiaries in the CDM data. MAE are estimates in the MA Encounter data from the same large insurance company represented in the CDM data for year 2016.