Comparing the Care Experiences of Medicare Advantage Beneficiaries With and Without Alzheimer's Disease and Related Dementias

David J. Meyers PhD; Maricruz Rivera-Hernandez PhD; Daeho Kim PhD; Laura M. Keohane PhD; Vincent Mor PhD; Amal N. Trivedi MD, MPH


J Am Geriatr Soc. 2022;70(8):2344-2353. 

In This Article

Abstract and Introduction


Background: The Medicare Advantage (MA) program is rapidly growing. Limited evidence exists about the care experiences of MA beneficiaries with Alzheimer's Disease and Related Dementia (ADRD). Our objective was to compare care experiences for MA beneficiaries with and without ADRD.

Methods: We examined MA beneficiaries who completed the Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) and used inpatient, nursing home, or home health services in the past 3 years. We classified beneficiaries with ADRD using the presence of diagnosis codes in hospitals, nursing homes, and home health records. Our key measures included overall ratings of care and health plan, and indices of receiving timely care, care coordination, receiving needed care, and customer service. We compared differences between beneficiaries with and without ADRD using regression analysis adjusting for demographic, health, and plan characteristics, and stratifying by proxy response status.

Results: Among beneficiaries sampled by CAHPS, 22.2% with ADRD completed the survey compared to 38.5% without ADRD. Among proxy responses, beneficiaries with ADRD were 4.2 (95% CI: 0.1–8.4) percentage points less likely to report a high score for receiving needed care, and 3.5 percentage points (95% CI: 0.2–6.9) less likely to report a high score for customer service. Among non-proxy responses, those with ADRD were 9.0 (95% CI: 5.5–12.5) percentage points less likely to report a high score for needed care, and 8.5 (95% CI: 5.4–11.5) percentage points less likely to report a high score for customer service.

Conclusions: ADRD respondents to the CAHPS were more likely to be excluded from CAHPS performance measures because they did not meet eligibility requirements and rates of non-response were higher. Among responders with or without a proxy, MA enrollees with an ADRD diagnosis reported worse care experiences in receiving needed care and in customer service than those without an ADRD diagnosis.


The Medicare Advantage (MA) program is rapidly growing and now accounts for over 42% of Medicare beneficiaries nationally.[1,2] MA differs from traditional Medicare (TM) in that private plans are paid on a capitated basis to cover the needs of their enrollees in a year. MA plans can offer additional supplemental benefits unavailable in TM.[3] But they can also set specific networks of available providers[4] and implement prior authorization requirements that may pose additional challenges for enrollees with chronic conditions.

Alzheimer's Disease and related dementias (ADRD) is a highly prevalent condition that is responsible for substantial care and cost burdens nationally.[5–9] Individuals with ADRD and their caregivers often face additional barriers in access to care compared to other patients in the healthcare system. While both the MA program and the prevalence of ADRD continue to grow, there is currently limited evidence on the care experience of Medicare beneficiaries with ADRD in the MA program. While two recent studies have found substantially higher disenrollment rates for enrollees with ADRD from MA plans, few studies have examined the care experiences of MA enrollees with ADRD.[10,11] Additionally, given that beneficiaries with ADRD may have cognitive decline or may be more likely to be institutionalized, it is unclear if their experiences are captured by current performance measurement initiatives.

In this study, we use a unique linkage of national survey data with claims and assessment data to examine the care experiences of MA enrollees with ADRD. Our two primary objectives are to understand the extent to which beneficiaries with ADRD are included in CAHPS performance measurement and to measure how the care experiences of enrollees with ADRD compared to those without.