Research: Access Issues Drive People Back to Traditional Medicare

Previously, researchers have had a difficult time getting access to data that could help them understand what drives older Americans to switch Medicare Advantage (MA) plans or to leave MA for traditional Medicare. But a new study in the June issue of Health Affairs examines some of those motivations. 

The inability to access the care they needed, and dissatisfaction with the quality of the care they received, had much more to do with switching to another MA plan than the costs they had to pay, the study finds. But access issues were much more likely to drive someone out of MA completely and back to traditional Medicare.

Geoffrey Hoffman, Ph.D., the lead author of the new study and an associate professor in the University of Michigan School of Nursing, said the study also shows that people who enrolled in an MA plan with a low star rating – which they may or may not have been aware of unless they checked Medicare’s Plan Finder – were also more likely to switch.

“The idea of the private market for Medicare Advantage plans is that people are supposed to shop around as their needs evolve, but with medical care you likely need to experience it before you know whether you want to switch,” Hoffman said in a statement. “We show that people who stay in MA are shopping for better service, but that those who switch to traditional Medicare are the ones potentially with high healthcare needs, who are much more strongly driven by dissatisfaction with access to care issues in MA.”

Those who said their health is poor were more than twice as likely as other MA enrollees to say they had trouble getting care they needed, more than three times as likely to be dissatisfied with the quality of their care, and more than twice as likely to be dissatisfied with the cost of their care and with their specialty care. About 15% of the study sample reported being in poor health.

But overall, dissatisfaction with cost wasn’t associated with leaving an MA plan. Access to care and quality of care were – as were enrollment in a plan with a low star rating and low generosity of benefits.

The new findings about people in poor health leaving for traditional Medicare confirm research by others, but in a patient-centered way instead of one based on billing. That’s because Hoffman and his colleagues used anonymous data about satisfaction with medical care access, cost, and quality from surveys that Medicare beneficiaries take each year, and linked it to anonymous data about MA enrollment.

The new study also suggests that the star ratings system, which assigns one to five stars to each MA plan based on a combination of data including participant surveys, can be a good guide to help people choose a plan.

“While imperfect, the star rating a plan receives is still signaling something important, that our study tells us is definitely linked to why people are switching,” Hoffman added.

The study used Medicare Current Beneficiary Survey data linked to anonymized information about the 3,600 people whose surveys they reviewed; the surveys had been taken after the individuals had been in their Medicare Advantage plan for at least 8 months. The researchers excluded data from some groups of older adults with special circumstances such as eligibility for Medicare for people with low incomes, and people enrolled in Medicare before age 65 because of disability or kidney failure.