A new study published in the June issue of Health Affairs reveals the major factors that motivate Medicare Advantage members to switch plans during open enrollment or leave the private insurance program altogether. Spoiler alert: Cost isn’t the main reason.
To determine the drivers that cause Medicare Advantage members to reconsider their coverage, researchers analyzed depersonalized Medicare Current Beneficiary Survey data of 3,600 people who had been in their Medicare Advantage plan for at least eight months. They linked the members' satisfaction with medical care access, cost, and quality from the annual surveys to anonymous data about Medicare Advantage enrollment.
Overall, researchers learned that dissatisfaction with cost wasn’t associated with leaving a Medicare Advantage plan.
Instead, the research team found that members who have trouble accessing necessary care and are dissatisfied with the quality of the care they received were why they switched plans. However, inability to access care was the primary reason members left Medicare Advantage to return to traditional Medicare, which doesn’t limit the selection of doctors and hospitals that members can visit.
Dissatisfaction with access was especially common among those who describe their health as poor (15 percent of the study sample), lead author Geoffrey Hoffman, Ph.D., MPH, associate professor for the Department of Systems, Populations, and Leadership at the University of Michigan School of Nursing, told the University of Michigan School of Nursing.
Indeed, those in poor health were more than three times as likely to be dissatisfied with the quality of their care and more than twice as likely to be dissatisfied with the cost of their care and with their specialty care.
Other predictors of switching behavior: whether they enrolled in either a Medicare Advantage plan that had a low Star rating or one that offered benefit-rich coverage. People in more generous plans were less likely to switch, he said. But those in a low Star rating plan were more likely to switch plans.
“The idea of the private market for Medicare Advantage plans is that people are supposed to shop around as their needs evolve, but with medical care, you likely need to experience it before you know whether you want to switch,” Hoffman said. “We show that people who stay in MA are shopping for better service, but that those who switch to traditional Medicare are the ones potentially with high health care needs, who are much more strongly driven by dissatisfaction with access to care issues in MA.”