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Medicare Advantage Beneficiary Enrollment Decisions Following New Complex Conditions
Mark Katz Meiselbach, Jianhui Xu, Teneil Brown, Daniel Polsky. JAMA Health Forum, 2026-08-21
Topic: Risk, prevention and care in population studies
The analytic sample included 1 054 926 beneficiaries, including 219 942 (mean [SD] age, 75.3 [6.3] years; 54.6% female) who developed new complex conditions in 2019 and 834 984 (mean [SD] age, 73.8 [5.6] years; 56.7% female) who did not develop a new complex condition in 2019. Developing any new complex condition was associated with an increase of 3.3 (95% CI, 3.1-3.5) percentage points (pp) in MA disenrollment, including an increase of 2.8 (95% CI, 2.7-2.9) pp in disenrollment to TM. The number of new complex conditions was associated with increased disenrollment, from 1.4 (95% CI, 1.3-1.6) pp for 1 condition to 12.8 (95% CI, 11.6-13.9) pp for 4 or more conditions. Disenrollment to TM was 1.5 (95% CI, 0.9-2.1) pp higher among beneficiaries residing in states with Medigap guaranteed issue and community rating protections. Conclusions and Relevance: In this study, development of new complex medical conditions was associated with higher MA disenrollment, particularly to TM and in states with Medigap protections, and the magnitude increased with medical complexity. These findings highlight how changes in health status and state policy may shape Medicare coverage decisions.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Meiselbach, M. K., Xu, J., Brown, T., & Polsky, D. (2026). Medicare Advantage Beneficiary Enrollment Decisions Following New Complex Conditions. JAMA Health Forum. https://doi.org/10.1001/jamahealthforum.2026.2843
Vancouver
Meiselbach MK, Xu J, Brown T, Polsky D. Medicare Advantage Beneficiary Enrollment Decisions Following New Complex Conditions. JAMA Health Forum. 2026. doi:10.1001/jamahealthforum.2026.2843. PMID: 42627656.
BibTeX
@article{meiselbach2026-42627656,
author = {Meiselbach, Mark Katz and Xu, Jianhui and Brown, Teneil and Polsky, Daniel},
title = {{Medicare Advantage Beneficiary Enrollment Decisions Following New Complex Conditions}},
journal = {JAMA Health Forum},
year = {2026},
doi = {10.1001/jamahealthforum.2026.2843},
pmid = {42627656},
url = {https://doi.org/10.1001/jamahealthforum.2026.2843}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- The analytic sample included 1 054 926 beneficiaries, including 219 942 (mean [SD] age, 75.3 [6.3] years; 54.6% female) who developed new complex conditions in 2019 and 834 984 (mean [SD] age, 73.8 [5.6] years; 56.7% female) who did not develop a new complex condition in 2019.
- Developing any new complex condition was associated with an increase of 3.3 (95% CI, 3.1-3.5) percentage points (pp) in MA disenrollment, including an increase of 2.8 (95% CI, 2.7-2.9) pp in disenrollment to TM.
- The number of new complex conditions was associated with increased disenrollment, from 1.4 (95% CI, 1.3-1.6) pp for 1 condition to 12.8 (95% CI, 11.6-13.9) pp for 4 or more conditions.
- Disenrollment to TM was 1.5 (95% CI, 0.9-2.1) pp higher among beneficiaries residing in states with Medigap guaranteed issue and community rating protections.
- Conclusions and Relevance: In this study, development of new complex medical conditions was associated with higher MA disenrollment, particularly to TM and in states with Medigap protections, and the magnitude increased with medical complexity.
Why it matters
This study examined whether developing new complex medical conditions was linked to disenrollment from Medicare Advantage. It is about insurance coverage decisions rather than treating, curing or preventing Alzheimer's disease.
Study details
- Study designcohort study
- Effect size54.6%; 56.7%
- Evidence strengthModerate
How this study scored 59/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, studied in people and randomized / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 38 of the 64 points we could judge it on, which is 59 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (JAMA Health Forum) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42627656) |
| Free to read | 2 / 2 | Free to read |
| Points | 38 / 64 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 38 of the 64 points we could judge it on is 59 out of 100. |
| Total | 59 / 100 | — |
What each of these 20 components measures, and what this score is not →
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