Telehealth among Medicare Advantage beneficiaries with and without Alzheimer's Disease and Related Dementias (ADRD), 2018–2024: from pandemic-era surge to post-pandemic decline

Telehealth has become a vital element of healthcare delivery, especially among Medicare Advantage (MA) beneficiaries. Yet its use among individuals with Alzheimer’s Disease and Related Dementias (ADRD) – a population with complex biopsychosocial needs – remains understudied. We conducted an observational cohort study of MA beneficiaries aged 65 and older using Optum’s de-identified Clinformatics® Data Mart Database (January 2017–June 2024). A matched sample of enrollees with and without ADRD was constructed. Difference-in-differences and event study analyses were applied to evaluate adjusted differences in quarterly telehealth utilization before and after the 2020 Medicare telehealth policy expansion during the COVID-19 public health emergency. The primary outcome was a quarterly indicator of any telehealth use, defined among enrollee-quarters with any medical claim. Among 421,131 MA beneficiaries, telehealth use increased sharply in Q2 2020 for both ADRD and non-ADRD groups, peaking at 33.9 and 30.6% respectively. Use declined and stabilized by 2021, remaining slightly higher among beneficiaries with ADRD by Q2 2024. Adjusted DiD analyses showed a small but statistically significant post-2020 increase in telehealth use for the ADRD group compared to the non-ADRD group (2.58 percentage points; p < 0.01), with the gap narrowing over time. Findings are based on one national MA claims database and may not generalize to other populations or settings. MA beneficiaries with and without ADRD rapidly adopted telehealth following the 2020 policy expansion. Although use was initially higher among those living with ADRD, utilization converged over time. As telehealth policy evolves, it is critical to address barriers for cognitively impaired populations.