What Is Driving Medicare Advantage Beneficiaries to Disenroll or Switch Plans?

Research published in JAMA Internal Medicine concluded that high-need Medicare Advantage (MA) beneficiaries and Medicare-Medicaid eligible enrollees are disenrolling or switching plans at a much higher rate than other enrollees.

The cross-sectional study of more than 13.9 million MA enrollees found that among high-need enrollees (including patients with chronic illnesses), 4.6% of Medicare-only and 14.8% of Medicare-Medicaid beneficiaries switched to traditional Medicare compared with 3.3% and 4.6%, respectively, among non–high-need enrollees. The study also found that 15% of dual-eligible enrollees switched into MA from traditional Medicare plans.

Leading study authors at Brown University, David J Meyers, MPH, Emmanuelle Belanger, PhD, and Nina Joyce, PhD, sought to discover what influenced patient decisions and whether or not that care coverage was meeting the needs and preferences of enrollees; the study also found correlations between disenrollment and plan quality ratings. The results showed:

Even in high-quality plans, high-need members disenrolled at higher rates than non–high-need members, 4.9% vs 1.8% for Medicare-only enrollees and 11.3% vs 2.4% dual eligible enrollees.

Enrollment in a 5.0-star rated plan was associated with a 30.1–percentage point
reduction, 95% for enrollees with a chronic illness—in the probability of disenrollment among high–need individuals.

A $100 increase in monthly premiums was associated with a 33.9–percentage point increase (95% CI, −34.9 to −33.0 percentage points) in the likelihood of switching plans, and a small reduction in the likelihood of disenrolling.

“This study’s findings suggest that star ratings have the strongest association with disenrollment trends, whereas increases in monthly premiums are associated with greater likelihood of switching plans,” said Mr Meyers and colleagues. “Our findings suggest that caution is warranted when evaluating the performance of MA plans owing to the potential for selection bias stemming from differential disenrollment.”

At the time of the study, disenrollment is only 1 of 35 to 45 factors measured in the MA star ratings system. Mr Meyers and colleagues continued, “Weighting disenrollment more heavily may help incentivize plans to address these concerns further. Although MA may have the potential to provide greater care coordination to address complex patient needs, it is unclear whether high-need enrollees who stand to benefit the most from care coordination are in fact benefiting.”—Edan Stanley