Beneficiaries’ Chronic Conditions Did Not Drive MA to FFS Switching Rates

Beneficiaries with multiple chronic conditions did not have higher rates of switching between Medicare Advantage and Medicare fee-for-service (FFS), according to a study published in JAMA.

As Medicare Advantage enrollment grows, concerns about access to care for high-needs beneficiaries remain. Restrictive provider or hospital networks and utilization management processes, including prior authorization, may make it harder for beneficiaries with chronic conditions to receive necessary care.

Researchers used data from the Medicare Current Beneficiary Survey from 2009 to 2019 to determine whether Medicare Advantage beneficiaries with multiple chronic conditions were more likely to switch from Medicare Advantage to Medicare FFS.

A beneficiary was considered to have switched if they were enrolled in Medicare Advantage at the end of a year and subsequently enrolled in Medicare FFS the following year or vice versa. The number of chronic conditions was grouped by zero to one, two to three, four to five, and six or more.

The sample included 15,403 Medicare Advantage beneficiaries and 28,627 FFS beneficiaries. The researchers found that overall adjusted mean switching rates from Medicare Advantage to FFS were not significantly associated with a beneficiaries’ number of chronic conditions.

The rate of switching from Medicare Advantage to FFS was 4.0 percent for beneficiaries with zero to one chronic condition, 3.4 percent for those with two to three conditions, 2.8 percent for beneficiaries with four to five conditions, and 4.0 percent for those with six or more.

The mean Medicare Advantage disenrollment rate decreased between 2010 and 2011 and 2012 and 2013. After 2013, the disenrollment rate was stable for beneficiaries with and without chronic conditions. Switching rate trends did not differ by the number of chronic conditions, the study indicated.

Switching rates from FFS to Medicare Advantage were not significantly associated with the number of chronic conditions beneficiaries had either. The mean rates of switching from FFS to Medicare Advantage were stable between 2010 and 2011 and 2016 and 2017 before increasing to 5.8 percent between 2018 and 2019.

Stratified analyses found that dual-eligible beneficiaries had higher Medicare Advantage disenrollment rates than non-dual-eligible beneficiaries, but the rates did not differ across chronic condition groups for either population.

Past research has found that Medicare Advantage disenrollment rates were higher among beneficiaries with a specific condition or new functional disability. However, the recent study findings offer opposing notions.

The number of chronic conditions may not have impacted Medicare Advantage switching rates because the current risk-adjusted payments may have minimized incentives for Medicare Advantage plans to avoid high-risk beneficiaries. Additionally, Medicare Advantage plans may aim to keep sicker patients enrolled so they can receive higher revenue from risk-adjusted payments.

Despite perceived care barriers in Medicare Advantage, these plans have lower out-of-pocket costs and offer supplemental benefits, which may help beneficiaries with multiple chronic conditions manage their health needs.

However, the study noted that additional research should focus on the share of beneficiaries who disenroll from Medicare Advantage and how well Medicare Advantage plans meet the needs of those with chronic conditions.