Maricruz Rivera-Hernandez, PhD, David J Meyers, PhD, MPH, Daeho Kim, PhD, Sungchul Park, PhD, MPH, Amal N Trivedi, MD, MPH
Abstract
Objectives
The objective of this study was to identify rates of switching to Medicare Advantage (MA) among fee-for-service (FFS) Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) by race/ethnicity and whether these rates vary by sex and dual eligibility status for Medicare and Medicaid.
Methods
Data came from the Medicare Master Beneficiary Summary File from 2017-2018. The outcome of interest for this study was switching from FFS to MA during any month in 2018. The primary independent variable was race/ethnicity including non-Hispanic White, non-Hispanic African American, and Hispanic beneficiaries. Two interaction terms among race/ethnicity and dual eligibility, and race/ethnicity and sex were included. The model adjusted for age, year of ADRD diagnosis, the number of chronic/disabling conditions, total health care costs, and ZIP code fixed effects.
Results
The study included 2,284,175 FFS Medicare beneficiaries with an ADRD diagnosis in 2017. Among dual eligible beneficiaries, adjusted rates of switching were higher among African American (1.91 percentage points [p.p.], 95% CI: 1.68 to 2.15) and Hispanic beneficiaries (1.36 p.p., 95% CI: 1.07 to 1.64) compared to non-Hispanic White beneficiaries. Among males, adjusted rates were higher among African American (3.28 p.p., 95% CI: 2.97 to 3.59) and Hispanic beneficiaries (2.14 p.p., 95% CI: 1.86 to 2.41) compared to non-Hispanic White beneficiaries.
Discussion
Among persons with ADRD, African American and Hispanic beneficiaries are more likely than White beneficiaries to switch from FFS to MA. This finding underscores the need to monitor the quality and equity of access and care for these populations.