Understanding the reasons why Medicare beneficiaries voluntarily disenroll from Medicare Advantage and Part D Drug Plans: Findings from a national patient experience survey

Surveys of health plan disenrollees can be used to improve the quality of care and services. This study sought to understand the reasons why Medicare beneficiaries disenrolled from their Medicare Advantage Plans (MA) and Prescription Drug Plans (PDP) and to explore variations by beneficiary characteristics (race/ethnicity, dual-eligibility status), type of plan, and region.

A random sample of disenrollees from MA and PDP plans were surveyed as part of CMS’s 2013 Medicare PDP and MA plan disenrollment survey (N= 55,341 completes). Five composite measures of reasons for voluntary disenrollment (financial, prescription drug benefits and coverage, health plan patient experience, prescription drug patient experience, and coverage of doctors and hospitals) were constructed using multilevel confirmatory factor analysis. We calculated composite scores for contracts, beneficiaries, and subgroups of beneficiaries, using effect sizes to characterize variation across regions and subgroups. Results were adjusted for age, education, self-reported general and mental health status, state, low-income subsidy, dual eligibility, and proxy assistance.

MA disenrollees endorsed financial reasons (27.7% of items endorsed) and reasons related to coverage of doctors and hospitals (22.5%) most frequently—overall and in each of the nine census divisions— with plan patient experience (13.6%), prescription drug patient experience (9.5%), and prescription benefits and coverage (8.3%) less frequently endorsed. Regional variation was greatest among MA disenrollees for patient experience with plans. Financial reasons were also most commonly endorsed in all regions for PDP disenrollees (41.5% of composite items endorsed overall; less regional variation compared to MA disenrollees). Benefits and coverage was the next most commonly endorsed reason (13.0% of composite items) for PDP disenrollees. The largest effect sizes were observed by region for all reasons for both contract types. Among MA disenrollees, non-Hispanic Whites endorsed financial reasons more often (29.4%) than Asian Pacific Islanders (24.7%), Hispanics (23.9%), and African Americans (23.1%), but minority beneficiaries cited more total reasons for disenrollment than non-Hispanic Whites (similar pattern for PDP disenrollees). All correlations of financial reasons with other reasons are significantly negative, with the largest correlations being -0.6/-0.5 in MA/PDP.

Educational efforts to better convey the benefits and coverage and likely costs of Medicare plans may further improve beneficiaries initial plan choices.  Disenrollee surveys fill gaps in data collected by surveys of continuing enrollees. These results can be used by MA and PDP plans to improve quality and to reduce disenrollment, by CMS to monitor contract performance, and by Medicare beneficiaries to select plans and coverage.