Meyers DJ, et al. - Researchers investigated the trends of high-need Medicare beneficiaries switching to and from Medicare Advantage (MA) plans and what influenced these decisions. As per results, high-need and Medicare-Medicaid eligible enrollees had considerably higher disenrollment from MA plans. Disenrollment trends were observed to have the strongest association with plan quality ratings; a greater likelihood of switching plans increases correlated with monthly premiums.

Methods

• Researchers performed a cross-sectional study of MA and traditional Medicare (TM) enrollees from January 1, 2014 through December 31, 2015 using a multinomial logit regression stratified by Medicare-Medicaid eligibility status.
• For the analysis, eligible participants comprised all 14,589,645 non–high-need MA enrollees and 1,302,470 high-need enrollees in the US who survived until the end of 2014.
• From November 1, 2017 through August 1, 2018, analysis of data was done.
• Main outcomes assessed were the proportion of enrollees who disenrolled into TM, stayed in the same MA plan, or switched plans within the MA program.

Results

• This analysis included a total of 13,901,816 enrollees (56.2% women; mean [SD] age, 70.9 [9.9] years).
• Switching from MA to TM was observed in an adjusted 4.6% (95% CI, 4.5%-4.6%) of Medicare-only and 14.8% (95% CI, 14.5%-15.0%) of Medicare-Medicaid members among the 1,302,470 high-need enrollees compared with 3.3% (95% CI, 3.3%-3.3%) and 4.6% (95% CI, 4.5%-4.7%), respectively, among non–high-need enrollees.
• MA plan was left by 23.0% (95% CI, 22.3%-23.9%) of Medicare and 42.8% (95% CI, 40.5%-45.1%) of dual-eligible high-need enrollees, among enrollees in low-quality plans.
• High-need members displayed higher disenrolled rates vs non-high-need members even in high-quality plans (4.9% [95% CI, 4.6%-5.2%] vs 1.8% [95% CI, 1.8%-1.9%] for Medicare-only enrollees and 11.3% vs 2.4% dual eligible enrollees).
• The probability of disenrollment was reduced by 30.1–percentage point (95% CI, −31.7 to −28.4 percentage points) among high-need individuals in correlation with enrollment in a 5.0-star rated plan.
• A 33.9–percentage point increase (95% CI, −34.9 to −33.0 percentage points) in the likelihood of switching plans in addition to a small reduction in the likelihood of disenrolling (−2.7 percentage points; 95% CI, −3.2 to −2.2 percentage points) was observed in correlation with a $100 increase in monthly premiums.
• Switching from TM to MA was observed in 14.1% (95% CI, 14.0%-14.2%) of high-need and 16.7% (95% CI, 16.6%-16.7%) of non–high-need enrollees among Medicare-Medicaid eligible participants.