Project Summary Medicare beneficiaries with Alzheimer's Disease and Related Dementias (ADRD) typically require significant amounts of formal and informal healthcare. These treatments often lack coordination, conflict with patient and family preferences, and are costly to patients, families, and public payers. While most research has focused those in Traditional Medicare (TM), nearly half of Medicare beneficiaries are now enrolled in Medicare Advantage (MA), the managed care alternative to TM. MA plans receive flat, per-enrollee payments to incentivize efficient care and have flexibility in benefit design that enables them to offer expanded home care, concurrent palliative and curative care, and other services that may benefit complex ADRD patients. However, MA plans increasingly rely on predictive software and non-clinical care managers to make decisions about patient care, limiting plans' spending on patient care including use of these tools to deny many services that would be covered in TM. MA coverage denials may result in large bills for patients who must pay for necessary care out of pocket and/or greater reliance on help from family and friends, demands that can harm financial, physical, and mental well-being of informal caregivers. Additional spending or informal care use has the potential to further exacerbate socioeconomic disparities; out-of-pocket ADRD spending in the last 5 years of life represented 84% of wealth in Black households and 47% for those with less than a high school education. Thus, treatment decisions in MA can create intergenerational spillovers to the health and finances of patients' family members. In this grant, we study healthcare utilization and intergenerational transfers among patients who eventually develop ADRD using administrative and survey data. We ask 4 related questions to understand the impact of Medicare coverage choice on ADRD patients and their families: 1- Do ADRD patients experience more potentially preventable hospitalizations, burdensome transfers, and discharges without home care in MA vs. TM?; 2- Does MA mitigate or contribute to disparities in access to post-discharge care by race, ethnicity, or income among ADRD patients?; 3- Do intergenerational time and money transfers differ in ADRD families when the patient has MA vs. TM?; 4- Do posthumous family transfers differ in ADRD families with MA vs. TM? Wealth and housing are key social determinants of health. We may see widening disparities in subsequent generations If ADRD patients disproportionately need to rely on transfers from children in MA or TM or leave fewer resources to their children and grandchildren. With growing enrollment in MA, it is critical to understand the impacts on ADRD patients and families. Research on the value of MA has not yet considered whether MA shifts the burden of care to families, potentially imposing large and unappreciated social costs. Our team will consider these questions while working with the U54 coordinatin...