Voluntary disenrollment from Medicare advantage plans: valuable signals of market performance.

OBJECTIVE

To examine 2000-2005 trends in the reasons Medicare beneficiaries gave for disenrolling from their Medicare Advantage (MA) plans.

STUDY DESIGN

We used data from 6 consecutive years of Consumer Assessment of Health Plans surveys, which asked about 33 possible reasons for disenrollment, including problems with plan information, out-of-pocket costs, plan benefits, and coverage. Respondents numbered more than 50,000 beneficiaries each year from a variety of MA plan types providing full Medicare benefits in place of traditional fee-for-service Medicare. The survey also collected demographic and health status information.

METHODS

We classified reasons for disenrollment into 2 key groups: (1) reasons related to plan information and (2) reasons related to cost/benefits problems. We examined whether disparities existed between vulnerable and less vulnerable populations that might reflect different experiences by these groups over time.

RESULTS

Disparities between vulnerable and less vulnerable groups were present but generally diminished over time as competition intensified, with noticeable differences between African American and Hispanic subpopulations regarding problems with plan information.

CONCLUSIONS

The premise of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was that more plans would increase competition, resulting in higher-quality healthcare services. However, an increased number of plan choices complicates the health plan decision-making process for beneficiaries. With further expansion of plans and choices following implementation of Part D, efforts must continue to direct informational materials to all beneficiaries, particularly those in vulnerable subgroups. More help in interpreting the information may be required to maximize consumer benefits.