# Care for Persons with Dementia in Medicare Advantage and Traditional Medicare: Family Spillovers and Disparities

> **NIH NIH R01** · UNIVERSITY OF COLORADO DENVER · 2024 · $640,128

## Abstract

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...

## Key facts

- **NIH application ID:** 10977858
- **Project number:** 1R01AG089058-01
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Lauren Hersch Nicholas
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $640,128
- **Award type:** 1
- **Project period:** 2024-08-15 → 2029-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10977858

## Citation

> US National Institutes of Health, RePORTER application 10977858, Care for Persons with Dementia in Medicare Advantage and Traditional Medicare: Family Spillovers and Disparities (1R01AG089058-01). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10977858. Licensed CC0.

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