OTHER PROJECT INFORMATION – Project Summary/Abstract Cognitive Decline and Health Insurance Decisions and Outcomes This administrative supplement application proposes a new Center pilot project, to be conducted as part of the NBER Center for Aging and Health Research. The Center is structured around several high-priority research themes that are incubated and advanced through network meetings and pilot projects. While the NBER Center is not an Alzheimer’s-focused grant, the economics of Alzheimer’s disease has been identified by Center leaders as one of several high-priority themes for new research development. The proposed new pilot study explores how cognitive decline, including the onset and progression of mild cognitive impairment (MCI), Alzheimer’s disease, and related dementias (ADRD) relate to people’s health insurance enrollment decisions and subsequent outcomes. Medicare currently relies on a “managed competition” approach to supplemental insurance for long- term care, prescription drugs, and other coverage not included in traditional Medicare. In this approach, private insurers compete for enrollees within regulated markets. Some people, including those suffering from cognitive decline, may have difficulty navigating such markets, and the enrollment decisions they make may in turn affect other health outcomes. The specific aims of the pilot project are to explore how cognitive decline relates to: (1) the health insurance choice process, including the portfolio of coverage and use of assistance in making enrollment decisions; (2) inertia in insurance plan enrollment, defined as the likelihood of switching to plans that provide greater risk protection or lower costs; and (3) outcomes of Medicare Part D choices, describing how well each person fared under their chosen plan. The study will be conducted using a longitudinal database that tracks the onset and progression of cognitive decline among Medicare beneficiaries; their enrollment in Medigap plans, Medicare Part D prescription drug insurance plans, Medicare Advantage plans, employer-sponsored plans, and plans that provide long-term care coverage, including Medicaid; and many other health and health spending measures. The pilot research would provide the preliminary findings and support the methodological development for a larger R01 proposal that follows directly from the exploratory analyses described here.