Supplemental Medicare Insurance Coverage for Older Adults with Probable Dementia

In this paper, we compare supplemental Medicare insurance coverage among people with probable dementia (PWPD) and matched controls, before and after onset. This retrospective secondary data analysis of insurance coverage changes using propensity score weights and the 2000-2016 Health and Retirement Study (HRS). The sample consists of 3,001 Medicare-enrolled adults age 65 and older with PWPD, and 14,055 controls. Probable dementia is assessed with the Langa-Weir approach and interviewer assessments for proxy interviews. Four years before onset, PWPD become more likely to have Medicare without supplemental coverage (2.97 percentage points; p=0.0016) than matched controls. This reflects the net effect of PWPD being less likely to have Medicare Advantage or traditional Medicare with supplemental coverage, and more likely to have Medicaid. Two years before onset, PWPD were more likely to be Medicaid-eligible (4.95 percentage points, p<0.001), but take-up rates were comparable. Enrollment assistance may improve supplemental coverage for PWPD around dementia onset, potentially increasing financial access to care.