Medicare Advantage Enrollment and Outcomes of Post-Acute Nursing Home Care Among Patients with Dementia

Enrollment in Medicare Advantage (MA) has been rapidly growing. We examine whether MA enrollment affects the outcomes of post-acute nursing home care among patients with Alzheimer’s Disease and Related Dementias (ADRD). We exploit year-to-year changes in MA penetration rates within counties from 2012 through 2019. After adjusting for patient-level characteristics and county fixed effects, we find that MA enrollment was not associated with days spent at home, nursing home days, likelihood of becoming a long-stay resident, hospital days, hospital readmission, or 1-year mortality. There was a modest increase in successful discharge to community by 0.73 percentage points (relative increase of 2.4%) associated with a 10-percentage point increase in MA enrollment. The results are consistent among racial/ethnic subgroups and dual-eligible patients. These findings suggest an imperative need to monitor and improve quality of managed care among enrollees with ADRD.