Medicare Advantage members are most likely to disenroll from their health plan because of four main reasons: difficulty accessing care, low plan generosity, dissatisfaction with care quality, and the type of plan (HMO vs. PPO), according to a June study published in Health Affairs.
Using data from the 2015 to 2020 Medicare Current Beneficiary Survey, the study looked at both self-reported beneficiary experiences and objective measures of plan performance to identify the primary reasons for disenrollment. The researchers analyzed 6,196 observation-years from 3,631 MA enrollees, representing a sample of over 40 million beneficiaries.
The researchers observed no significant differences in the associations between MA plan dissatisfaction and disenrollments based on enrollees’ health status.
Four key reasons why members leave their Medicare Advantage plan:
Difficulty accessing care: Beneficiaries who reported trouble accessing necessary medical care were 1.33 times more likely to disenroll from their MA plan compared to those without access issues. MA members leaving for traditional Medicare had a 3.62 times higher risk of disenrollment due to access issues compared to those switching to another MA plan.
Low plan generosity: Beneficiaries enrolled in lower-generosity plans, which have higher out-of-pocket costs, had a 1.47 times greater risk of leaving their MA plan compared to those in more generous plans. However, dissatisfaction with costs alone did not appear to be a significant predictor of disenrollment, as those dissatisfied with costs had only a 1.03 times greater likelihood of leaving.
Dissatisfaction with care quality: Beneficiaries who were dissatisfied with the overall quality of care, including specialty care, were more likely to disenroll. Dissatisfaction with the overall quality of care increased the risk of disenrollment by 1.38 times. Additionally, beneficiaries in plans with lower star ratings (2 to 3.5 stars) faced a 1.75 times higher risk of leaving compared to those in higher-rated plans (4+ stars).
Plan type: Beneficiaries enrolled in regional PPOs were 1.35 times more likely to disenroll than those in HMOs. However, enrollment in local PPOs did not significantly affect disenrollment rates. Enrollment in a regional PPO (versus an HMO) was more strongly associated with the risk of exiting MA for traditional Medicare than for switching to another MA plan.
