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.