Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
JAMA Health Forum. 2023 Aug 4;4(8):e232717. doi: 10.1001/jamahealthforum.2023.2717.
The Medicare Advantage (MA) program is rapidly growing. While previous work has found that beneficiaries with substantial health needs disenroll from plans at higher rates, the long-term frequency of disenrollment is not well understood.
To compare cumulative disenrollment trends in the MA program by beneficiary and plan characteristics.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, serial cross-sectional study included beneficiaries with any MA enrollment from January 1, 2011, to December 31, 2020. Data analysis took place from September 2022 to March 2023.
Beneficiary characteristics, including race and ethnicity, length of Medicare enrollment, dual eligibility, and comorbidity burden, and contract characteristics, including vertical integration status, premium, and MA star rating.
The main outcome was disenrollment from an MA contract within 5 years. Rates of cumulative disenrollment by beneficiary and contract characteristics were compared. Pearson correlation coefficients were calculated to assess the correlation between a contract's 1-year disenrollment and the contract's disenrollment over a longer period.
The sample included 82 377 917 beneficiaries (524 442 225 beneficiary-year observations; 56.7% female; mean [SD] age, 71.9 [10.3] years). After 1 year, 13.2% of nondually enrolled and 15.9% of dually enrolled beneficiaries had left their contract, increasing to 48.3% and 53.4%, respectively, after 5 years. Black enrollees disenrolled at the highest rates among race and ethnicity categories, with 14.8% disenrolling after 1 year and 52.6% disenrolling after 5 years. Contracts had a median disenrollment rate of 9.8% (IQR, 4.5%-19.0%) after 1 year and 56.1% (IQR, 23.1%-79.0%) after 5 years. Contracts rated 5 stars had substantially lower 5-year disenrollment rates (23.0% after 5 years compared with 41.2% for 4- to 4.5-star contracts and 67.2% for 3- to 3.5-star contracts). Disenrollment from a contract after 1 year was not well correlated with disenrollment after 5 years (r, 0.46).
This cross-sectional study found substantial cumulative rates of disenrollment from MA plans within 5 years between 2011 and 2020, with wide variation in 5-year disenrollment by contract. The findings suggest that evaluating long-term disenrollment rates in MA performance measures may capture different outcomes than single-year disenrollment alone.
医疗保险优势（MA）计划正在迅速发展。虽然之前的研究发现，有大量健康需求的受益人退出计划的比例更高，但长期退出的频率尚不清楚。
按受益人和计划特征比较 MA 计划中累积退保趋势。
设计、设置和参与者：这是一项回顾性、连续的横断面研究，纳入了 2011 年 1 月 1 日至 2020 年 12 月 31 日期间任何 MA 参保的受益人。数据分析于 2022 年 9 月至 2023 年 3 月进行。
受益人的特征，包括种族和民族、医疗保险登记年限、双重资格和合并症负担，以及合同特征，包括垂直整合状况、保费和 MA 星级评级。
主要结果是在 5 年内退出 MA 合同。按受益人和合同特征比较累积退保率。计算了 Pearson 相关系数，以评估合同 1 年退保率与较长时期内合同退保率之间的相关性。
样本包括 82377917 名受益人（52444225 名受益人的观察年；56.7%为女性；平均[SD]年龄为 71.9[10.3]岁）。1 年后，无双重资格的非双重参保者中有 13.2%退出了合同，5 年后增加到 48.3%；有双重资格的参保者退出率从 15.9%增加到 53.4%。在种族和民族类别中，黑人参保者的退保率最高，1 年后退保率为 14.8%，5 年后退保率为 52.6%。合同在 1 年后的中位退保率为 9.8%（IQR，4.5%-19.0%），5 年后为 56.1%（IQR，23.1%-79.0%）。星级评定为 5 星的合同在 5 年内的退保率显著较低（5 年后为 23.0%，而 4-4.5 星级合同为 41.2%，3-3.5 星级合同为 67.2%）。合同在 1 年后的退保率与 5 年后的退保率相关性不强（r=0.46）。
这项横断面研究发现，2011 年至 2020 年间，MA 计划的退保率在 5 年内累积幅度较大，不同合同的 5 年退保率差异较大。研究结果表明，在 MA 绩效评估中评估长期退保率可能会捕获到与单一年度退保率不同的结果。
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