Why Do So Many Older Adults Switch Medicare Advantage Plans?

Did you know that more than half of older Americans now use a Medicare Advantage (MA) plan from a private insurance company? Every fall, during Open Enrollment, many of them either switch to a different MA plan or go back to traditional Medicare. But what makes people want to change? A recent study in Health Affairs finally gives us some answers.

It’s Not Just About the Money

Researchers found that most people who switch from one MA plan to another aren’t just worried about costs. Instead, the main reasons are trouble getting the care they need and not being happy with the quality of care. If someone can’t access the doctors or treatments they need, or they’re not satisfied with the care they get, they’re much more likely to change plans.

However, when people leave MA altogether and go back to traditional Medicare, it’s usually because of even bigger access issues—especially for those who have poor health. In fact, people who say their health isn’t good are the most likely to switch plans or leave MA completely.

 

Plan Ratings Matter

Geoffrey Hoffman, the lead researcher, points out that people who are enrolled in plans with low star ratings (which measure things like quality and satisfaction) are more likely to switch. These ratings can be found on Medicare’s Plan Finder, but not everyone checks them before signing up.

He also mentions that while MA plans are supposed to let people “shop around” for what fits their needs, it’s hard to know if a plan works for you until you actually use it. So, many people end up switching after they’ve had some experience with their plan.

 

Who’s Most Dissatisfied?

The study found that people in poor health are much more likely to be unhappy with the quality, dissatisfied with associated costs, and have trouble getting care. Even so, cost isn’t the main reason people leave MA plans: issues with access and quality are much bigger factors.

When someone is frustrated with getting the care they need, they’re more likely to leave MA and return to traditional Medicare, which generally lets you see more doctors and hospitals. Interestingly, MA plans do have caps on out-of-pocket costs, which traditional Medicare plans don’t typically include, but that doesn’t seem to be the big deciding factor.

What Happens When People Leave MA?

When people with high health needs move back to traditional Medicare, it impacts government spending and how insurance companies get paid. It can also affect the amount people pay out-of-pocket, especially since not all states let you easily buy a Medigap plan (which helps cover extra costs) after leaving MA. So, some folks might end up with more medical bills if they can’t get this extra coverage.

 

A Closer Look at the Study

The researchers looked at survey data from about 3,600 people who had been in their MA plan for at least eight months. They focused on older adults and left out special cases, like those with low incomes or certain disabilities. In short, they found that most people switch Medicare Advantage plans because they’re unhappy with their care or can’t get the services they need, not just because of cost. And those in poorer health are the most likely to make a change, especially if they’re frustrated by access issues. Plan ratings and benefits also play a role, so it’s smart to check those before picking a plan.