New Condition, New Decisions: Medicare Advantage Disenrollment Decisions Following New High-Need Conditions

• In Event: Responding to High-Need Populations: Medicare Policy in Action

Abstract

Over half of Medicare beneficiaries in the United States are now enrolled in the privately administered Medicare Advantage (MA) program. Enrollment in MA compared to traditional Medicare (TM) is often a tradeoff between out-of-pocket limits and supplemental benefits in MA and diminished hassles to access health care in TM. Though an enrollee might understand these tradeoffs at the time of enrollment, their preferences may change if their underlying health status changes. This study evaluates 1) whether individuals enrolled in MA who develop new complex health conditions are more likely to disenroll from their plans and 2) whether disenrollment varies by state supplemental Medicare insurance community rating policies or plan characteristics.

Using 2016-2019 Medicare administrative claims and enrollment data, we identified a cohort of people enrolled in an MA plan for two consecutive years (2016-2017) without one of nine high-need health condition (e.g., acute myocardial infarction, dementia). We then compared enrollment decisions between a treatment group of enrollees (N=229,675) who developed a high-need condition in year 3 (2018) to a comparison group of people who continued to not a high-need condition in year 3 (N=2,272,511). In regressions adjusted for demographics, state and plan fixed effects, and prior other chronic conditions, we compared rates of plan disenrollment between the two groups, assessing overall disenrollment and disenrollment to other MA plans or TM. Through regression-adjusted interactions, we then compared differences in disenrollment rates between the treatment and comparison groups 1) across states with vs. without community rating policies for Medicare TM supplemental insurance and 2) plan characteristics (i.e., network restrictiveness, plan average enrollee risk score).

Among people who developed a new depression diagnosis, 20.5% disenrolled from their MA plan, compared to 18.4% of the comparison group (a 2.1 percentage point (pp) difference). Among individuals with a new high-need condition that switched, 85.1% switched to another MA plan as opposed to Medicare TM. In states with community-rated TM supplemental insurance, the difference in disenrollment rates between the treatment and comparison groups was 1.1 pp higher, driven by higher rates of enrollment into TM. Differences in disenrollment were also elevated among people enrolled in health maintenance organization (HMO) plans (0.9 pp higher) and plans with below-average enrollee risk scores (0.3 pp), driven by switching to a different MA plan. Among all conditions assessed, the most elevated disenrollment rates were found in people who developed new conditions of depression, Alzheimer’s, and other related dementias.

People with a high-need condition diagnosis were more likely to disenroll from their MA plans. Our findings suggest that supplementary insurance regulations may make it easier for these individuals to enroll in TM, whereas plan-driven disenrollment decisions are more likely to result in switching to a different plan within MA.

Authors

• Mark Katz Meiselbach, Johns Hopkins University
  Presenting Author

• Jianhui Xu, Johns Hopkins University
  Non-Presenting Co-Author

• Teneil K Brown
  Non-Presenting Co-Author