Medicare Advantage Disenrollment

Medicare Advantage continues to experience rapid growth, now representing about 35% of all Medicare beneficiaries.  People’s satisfaction with the plans participating in the program can be measured in part by their rates of disenrollment and switching, and such information can be useful for policymakers and beneficiaries.  Research in the Journal of the American Medical Association, Internal Medicine, examines trends in this area.   (JAMA Int. Med. Article)   The authors focused on high-need beneficiaries, those with multiple diseases and functional impairments.  Such beneficiaries may benefit from the extra care coordination and benefits of MA plans, but may also be stymied in getting care by more restrictive provider networks and utilization management techniques like prior authorization.  The researchers looked at disenrollment or switching decision in 2014 and 2015 by these high-need beneficiaries.  In addition to considering health status, the authors looked at various demographic characteristics and plan characteristics like out-of-pocket spending requirements and star rating.

High-need beneficiaries had the greatest rate of MA disenrollment, about 2.6% of non-dual eligible ones left the highest rated plans and 10.6% disenrolled from the lowest rated ones.  Dual-eligible, high-need beneficiaries had higher disenrollment rates, 11.1% left the highest rated plans and 18.5% left the lowest rated ones.  Dual eligibles had high rates of joining MA from traditional Medicare as well, with 15% of all dual-eligibles, high and regular need, doing so.  Dual eligibles tended to have higher disenrollment rates than non-dual eligibles and high-need beneficiaries, whether or not dual eligible, had higher disenrollment rates as well.  Non-dual eligible high-need enrollees in a high-rated plan were 29% less likely to disenroll than a similar beneficiary in a low-rated plan.  Dual eligibles can switch any time of the year, unlike regular MA members, so that may account for some of the higher disenrollment rates.  The study also is not clear on whether disenrollment was always to traditional Medicare or was to another MA plan.  Plan switching doesn’t indicate dissatisfaction with the MA program; many times the switch is to a plan with lower premiums or cost-sharing or better supplemental benefits.  What would be more helpful than raw disenrollment or switching data is extensive survey results to identify specific reasons for changing.