Medicare Advantage enrollees with dementia had fewer home-based medical visits

Researchers analyzed 2021–2022 Medicare claims and encounter data to compare 2022 outpatient visits among community-living Traditional Medicare (TM) and Medicare Advantage (MA) enrollees with Alzheimer’s disease and related dementias. Visits were categorized as home-based medical care (HBMC), telemedicine or office-based. The study used propensity weighting and regional fixed effects to adjust comparisons between plan types.

Among 49,194 TM and 47,830 MA enrollees, adjusted HBMC visit counts were 25% lower in MA (incidence rate ratio [IRR], 0.75; 95% CI, 0.69–0.81). This reflected 19% lower incidence of receiving HBMC and 7% lower visit intensity. Overall visits were 10% lower in MA (IRR, 0.90; 95% CI, 0.88–0.93); office visits were 6% lower, while telemedicine use was similar. HBMC visits were lower in MA by 47% among non-Hispanic Black enrollees, 67% among Hispanic enrollees and 42% among those eligible for Medicaid. Within MA, PPO enrollees had more HBMC visits than HMO enrollees.

The findings identify differences in service use, not their causes or effects on health outcomes. Claims-based comparisons may not capture all care, and the authors call for further research and targeted interventions to support equitable access.