Seniors with cognitive impairments are overwhelmed by options in Medicare Advantage, a new study suggests.

Medicare Advantage, or Medicare Part C, offers beneficiaries a number of different private managed care insurance options, such as hospital, drug and medical coverage. But Harvard Medical School researchers say the variety of plans can be overwhelming for seniors with impaired cognition, who ironically could benefit the most.

To study how cognitive function affects enrollment in Medicare Advantage versus traditional Medicare, the Harvard researchers looked at 21,815 enrollment decisions made over three years by 6,672 participants. The investigators compared these decisions between participants with varying cognition levels.

They found that beneficiaries with impaired cognition were significantly less likely than beneficiaries with higher cognition to appreciate the advantages offered by enrolling in Medicare Advantage plans. The researchers suggest this shows that beneficiaries, overwhelmed by the options in Medicare Advantage, chose traditional Medicare by default.

“Efforts to limit choice and guide seniors to the most valuable options could especially benefit those with cognitive impairments, who without more help appear to be leaving money on the table,” Harvard researcher J. Michael McWilliams, M.D., wrote. “Better enrollment decisions could in turn strengthen competition by rewarding high-value plans with more enrollees.”

The study was published online in Health Affairs on Aug. 18.