Medicare Advantage Disenrollment Rates Can Help Beneficiaries Make Informed Decisions

Beneficiaries enrolled in Medicare Advantage (MA) plans have opportunities to disenroll from their plans and either return to traditional Medicare or switch to a different MA plan. In some circumstances, disenrollment is voluntary; in others, beneficiaries are forced to disenroll. For instance, beneficiaries may be required to disenroll if they change residences outside the plan’s service area, lose Medicare eligibility, or if Medicare terminates a plan’s contract. Beneficiaries also may be involuntarily disenrolled if they fail to pay premiums. Beneficiaries may choose to leave their plan if they are dissatisfied with providers covered, if their medical needs change, or if out-of-pocket costs are too high.

Looking at disenrollment rates can shed light on the quality of MA plans. High voluntary rates of disenrollment likely mean poor patient experiences and suggest a plan may not be meeting beneficiaries’ needs. People also disenroll from plans when they learn that different coverage options may be a better fit for their needs. Research has found that people with chronic conditions and low incomes are more likely to disenroll from MA plans. Plan requirements that make it difficult to navigate the health care system, such needing to obtain prior authorization for a service or limitations in coverage of out-of-network services, may contribute to larger rates of disenrollment in these high-need populations. Regardless of the reason, disenrollment from an MA plan results in disruptions in care.

Rates of and Reasons for Disenrollment

Data from the Centers for Medicare and Medicaid Services indicate that across all Medicare contracts with insurers, an average of 17 percent of enrollees voluntarily disenrolled from an MA plan in 2021.¹ This represents an increase of about 70 percent since 2017, when the disenrollment rate averaged only 10 percent.

Plan coverage issues and financial concerns were reported by almost one-quarter of beneficiaries who disenrolled. On average, across MA contracts, 23 percent of beneficiaries reported that the decision to leave their plan was driven, at least in part, by coverage problems with physicians and hospitals. A similar proportion of beneficiaries reported their decision was driven by costs, including high premiums and out-of-pocket expenses; lack of coverage of a needed benefit; or the perception that another plan offered better services.

An average of 18 percent of beneficiaries who disenrolled from an MA plan indicated that problems getting the plan to cover services caused them to leave the plan. This could include difficulty in getting claims paid, problems with the approval process, denial of services, or the inability to get needed care. Customer service issues, such as problems obtaining accurate information about how the plan works, were cited by an average of 13 percent of disenrolled beneficiaries. Finally, issues concerning prescription drugs and benefits, such as plans’ lack of coverage of selected prescription drugs, difficulty getting name-brand drugs, and changes in drug formularies, were cited by an average of 9 percent of beneficiaries who disenrolled.

Disenrollment Data as a Tool for Informed Decision-Making

Information on each plan’s disenrollment rate and the reasons plan members disenrolled could help beneficiaries during open-enrollment or special-election periods to decide whether to stick with their current plans, return to traditional Medicare, or switch to other MA plans. This information may be of particular use to beneficiaries with chronic conditions or complex needs, who see doctors more often and require a greater degree of coordinated care.

While disenrollment rates are currently available on Medicare’s plan finder tool, the usefulness of the data is limited as these rates and other performance metrics are reported at the level of the insurer contract and not at the individual plan level. A contract may include multiple plans, including special needs plans, meaning that an insurer-level rate may not properly reflect the performance of specific plans under that insurer. Reasons for disenrollment are also reported for MA contracts, although these data are not as readily accessible to the public. More detailed performance data that include disenrollment rates and reasons for disenrollment — overall and by selected beneficiary characteristics (e.g., dual eligibility status, chronic condition) — would provide beneficiaries with more accurate data to assist in informed decision-making.

With the number of beneficiaries enrolling in Medicare Advantage soon exceeding those in traditional Medicare, accurate information on plan disenrollment will become increasingly important for policymakers looking to monitor plan effectiveness and for Medicare beneficiaries seeking to make informed health plan choices.