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Predictors of Disenrollment Among Medicare Fee-for-Service Beneficiaries With Dementia
Maricruz Rivera‐Hernandez, Aaron Castillo, Amal N. Trivedi. Innovation in Aging, 2021-12-01
Topic: Risk, prevention and care in population studies
Abstract Medicare enrollment among people with Alzheimer’s Disease and Related Dementias (ADRD) has reached an all-time high with about 12% of beneficiaries having an ADRD diagnosis. The federal government has special interest in providing healthcare alternatives for Medicare beneficiaries. However, limited studies have focused on understanding disenrollment from fee-for-service, especially among those with high-needs. In this study we identified predictors of disenrollment among beneficiaries with ADRD. We used the 2017-2018 Medicare Master Beneficiary Summary File to determine enrollment, sociodemographic, clinical characteristics and healthcare utilization. We included all fee-for-service beneficiaries enrolled in 2017 who survived the first quarter of 2018. Our primary outcome was disenrollment from fee-for-service between 2017 and 2018. Regression models included age, sex, race/ethnicity, dually eligibility to Medicare and Medicaid, chronic and disabling conditions (categorized by quartiles), total health care costs including outpatient, inpatient, post-acute care and other costs (categorized by quartiles) and county fixed-effects. There were 1,797,047 beneficiaries enrolled in fee-for-service with an ADRD diagnosis. Stronger predictors of disenrollment included race/ethnicity and dual eligibility. Disenrollment rates were 7.9% (95% CI, 7.2 – 8.5) among African Americans, 6.6 (95% CI, 6.2 – 7.0) among Hispanics and 4.3 (95% CI, 4.2 – 4.3) among Whites. Duals were 1.9% (95% CI, 1.4 – 2.3) more likely to disenroll from fee-for-service to Medicare Advantage (MA). The inclusion of MA special need plans and additional benefits for those with ADRD and complex chronic conditions may be valuable for those beneficiaries with ADRD, and who may not have Medigap coverage when enrolling in fee-for-service.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Rivera‐Hernandez, M., Castillo, A., & Trivedi, A. N. (2021). Predictors of Disenrollment Among Medicare Fee-for-Service Beneficiaries With Dementia. Innovation in Aging. https://doi.org/10.1093/geroni/igab046.062
Vancouver
Rivera‐Hernandez M, Castillo A, Trivedi AN. Predictors of Disenrollment Among Medicare Fee-for-Service Beneficiaries With Dementia. Innovation in Aging. 2021. doi:10.1093/geroni/igab046.062.
BibTeX
@article{riverahernandez2021-ac37c989,
author = {Rivera‐Hernandez, Maricruz and Castillo, Aaron and Trivedi, Amal N.},
title = {{Predictors of Disenrollment Among Medicare Fee-for-Service Beneficiaries With Dementia}},
journal = {Innovation in Aging},
year = {2021},
doi = {10.1093/geroni/igab046.062},
url = {https://doi.org/10.1093/geroni/igab046.062}
}
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
- There were 1,797,047 beneficiaries enrolled in fee-for-service with an ADRD diagnosis.
- Stronger predictors of disenrollment included race/ethnicity and dual eligibility.
- Disenrollment rates were 7.9% (95% CI, 7.2 – 8.5) among African Americans, 6.6 (95% CI, 6.2 – 7.0) among Hispanics and 4.3 (95% CI, 4.2 – 4.3) among Whites.
- Duals were 1.9% (95% CI, 1.4 – 2.3) more likely to disenroll from fee-for-service to Medicare Advantage (MA).
- The inclusion of MA special need plans and additional benefits for those with ADRD and complex chronic conditions may be valuable for those beneficiaries with ADRD, and who may not have Medigap coverage when enrolling in fee-for-service.
Why it matters
Among fee-for-service Medicare beneficiaries with an ADRD diagnosis, race/ethnicity and dual Medicare-Medicaid eligibility were the strongest predictors of disenrollment, with African American beneficiaries disenrolling at 7.9% versus 4.3% among White beneficiaries. This is about insurance enrollment patterns, not about treating, curing or preventing Alzheimer's disease.
Study details
- Effect size7.9%; 1.9%
- Evidence strengthLow
How this study scored 29/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Innovation in Aging) |
| Journal's citation record | 0 / 4 | Innovation in Aging: journal h-index 48 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 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 | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Amal N. Trivedi: h-index 42 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Brown University: institution h-index 1,120 (OpenAlex) |
| Multicenter collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 29 / 100 | — |
What each of these 20 components measures, and what this score is not →
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