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Medicare Advantage Plan Switching

By September 8, 2023Commentary

Medicare Advantage plans now enroll over half of all Medicare beneficiaries, including the majority of those who are dual eligibles also on Medicaid.  How long they stay in the Medicare Advantage program and how often they switch plans within the program could be an indicator of satisfaction with MA or the individual plan.  This study examined over 80 million people who were enrolled in an MA plan between 2011 and 2020 for patterns of disenrollment.  During this time, about 13% of regular MA enrollees and 15% of dual-eligibles had left a plan within one year, and 48% and 53%, respectively, had after five years.  Higher-rated plans had lower rates of disenrollment, but that may be confounded by the fact that higher rated plans get paid more and can therefore offer more extra benefits.    Interestingly there was no correlation between one-year and five-year disenrollment rates for the same plan.

There were aspects of the study which the researchers minimized.  While they call it disenrollment, the vast majority of beneficiaries who left an MA plan went to another MA plan.  The reasons for that are typically a lower premium or better benefits at a plan, or a provider network changes.  This is supported by the odd fact that plans with higher premiums actually saw less disenrollment, again likely because they offered more extra benefits.  Moving from one plan to another obviously would not support any notion of disatisfaction with the MA program or the care received under that program.

The authors interpret the data as indicating that plans would have low incentives to take good care of beneficiaries, since they won’t be enrolled for that long.  That is an absurd interpretation.  Plans are paid in part on the basis of quality of care rendered to members, so they have every incentive, regardless of how long they are in the plan, to identify and attend to the members’ health needs.  And since plans obviously don’t know which beneficiaries might disenroll, and because members whose health needs are met proactively are less likely to incur high costs, the plans are further incented to maximize every enrollees health.  And since the difference in disenrollment between those with the worst health status and those with the best was very small, feeling your care was unattended to seems an unlikely explanation.   (JAMA Article)

Join the discussion 2 Comments

  • Drake Lorence says:

    I can think of several other factors which may affect changing plans. First, the sales people involved maybe incentivised to move clients from one plan to another because of changes to the plan’s commission structure. It is not uncommon for insurance companies to increase comp to capture more market share. A powerful incentive for a broker. Secondly, retirees often move to another state within 5 years of retiring. It would then seem reasonable that some people changed plans in order to access new health systems and doctors they prefered in their new area. Their old plan may have access to the new state’s health systems. Third, studies seem to indicate there is a small but significant percentage of workers who will die within the first 5 years of retirement (see So, the widowed may decide to change plans after experiencing, first hand, how well their plan performed during the months preceding death of a spouse. All these are reasons to change

  • Pamela G Belcher says:

    Your analysis of disenrollment from Medicare Advantage plans didn’t mention the enrollment rules for Medicare Supplement plans. If a senior who is initially eligible for Medicare Coverage doesn’t choose a Medicare Supplement plan at their INITIAL enrollment opportunity, they may be unable to enroll in one in subsequent years. That is because initial enrollments in Med Supp plans are not medically underwritten. If the senior tries in future years to enroll in a Medicare Supplement plan and leave their current Med Advantage plan, medical underwriting may detect health issues which cause them to be rejected.

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