ResearchPosted on rand.org Feb 5, 2025Published in: Medical Care, Volume 59, Issue 9, pages 778-784 (September 2021). DOI: 10.1097/MLR.0000000000001574
Each year, about 10% of Medicare Advantage (MA) enrollees voluntarily switch to another MA contract, while another 2% voluntarily switch from MA to fee-for-service Medicare. Voluntary disenrollment from MA plans is related to beneficiaries' negative experiences with their plan, disrupts the continuity of care, and conflicts with goals to reduce Medicare costs. Little is known about racial/ethnic disparities in voluntary disenrollment from MA plans.
The objective of this study was to investigate differences in rates of voluntary disenrollment from MA plans by race/ethnicity. Subjects: A total of 116,770,319 beneficiaries enrolled in 736 MA plans in 2015.
Differences in rates of disenrollment across racial/ethnic groups [Asian or Pacific Islander (API), Black, Hispanic, and White] were summarized using 4 types of logistic regression models: adjusted and unadjusted models estimating overall differences and adjusted and unadjusted models estimating within-plan differences. Unadjusted overall models included only racial/ethnic group probabilities as predictors. Adjusted overall models added age, sex, dual eligibility, disability, and state of residence as control variables. Between-plan differences were estimated by subtracting within-plan differences from overall differences.
Adjusted rates of disenrollment were significantly (P<0.001) higher for Hispanic (+1.2 percentage points), Black (+1.2 percentage points), and API beneficiaries (+2.4 percentage points) than for Whites. Within states, all 3 racial/ethnic minority groups tended to be concentrated in higher disenrollment plans. Within plans, API beneficiaries voluntarily disenrolled considerably more often than otherwise similar White beneficiaries.
These findings suggest the need to address cost, information, and other factors that may create barriers to racial/ethnic minority beneficiaries' enrollment in plans with lower overall disenrollment rates.
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