High-Risk Patients More Likely to Exit MA Plans Due to Access and Quality

Dissatisfaction with access to and quality of care — rather than out-of-pocket costs — is the main driver of beneficiaries leaving their Medicare Advantage (MA) plans, particularly among those in poor health, according to a new study in the June 2025 issue of Health Affairs.

Enrollment in Medicare is expected to rise from 60 million in 2023 to 74 million in 2034, according to projections from the Congressional Budget Office (CBO). Enrollment in Medicare Advantage plans is growing, and that is also expected to continue. In 2023, more than half of beneficiaries were enrolled in Medicare Advantage plans, and the CBO projects that will rise to nearly two-thirds by 2034.

Medicare Advantage plans are offered by private insurance companies as an alternative to traditional Medicare, and they usually provide coverage for hospital services (Part A) and outpatient services (Part B), as well as prescription drugs (Part D). Although these plans often provide other services, their disadvantages include limited provider networks and may even result in higher costs for those who require complex medical care.

Geoffrey J. Hoffman, Ph.D., M.Ph.

Researchers — led by Geoffrey J. Hoffman, Ph.D., M.Ph., associate professor in the Department of Systems, Populations and Leadership at the University of Michigan — cited data that every five years up to 50% of enrollees switch Medicare Advantage plans, and 10% abandon Medicare Advantage plans in favor of traditional Medicare.

Researchers wanted to understand why people leave Medicare Advantage and whether it was because of beneficiaries’ perceptions of healthcare access, cost, and quality. They used nationally representative data from the 2015 to 2020 Medicare Current Beneficiary Survey, which includes information on beneficiaries’ perceptions, as well as Medicare Advantage contract star ratings and plan generosity data.

Researchers found that beneficiaries who left their Medicare Advantage plans reported worse experiences with healthcare access and quality in the previous year than those who stayed. “MA plan disenrollments were associated with beneficiary dissatisfaction with access and quality and, to a lesser degree, cost concerns, all of which were substantially worse for patients in poor health,” they wrote.

The findings point to a growing disconnect between the promises of Medicare Advantage plans and the lived experiences of enrollees with complex health needs. “Difficulty accessing needed medical care was more strongly associated with switching to traditional Medicare than changing to another MA plan,” the authors noted.

While cost concerns did not surface as strongly in self-reports, more generous plans were objectively linked to lower disenrollment, suggesting that plan design still plays a role in member retention. Similarly, CMS star ratings — which reflect consumer experiences with access and care quality — were associated with switching behavior, indicating they may influence enrollee perceptions and decisions.

Researchers said these results raise concerns about MA plans’ potential to underserve high-risk populations. Some experts warn of “favorable selection,” where Medicare Advantage plans may be structured to attract healthier individuals while driving out those with more costly medical needs through restrictive networks, benefit designs, and administrative hurdles like prior authorization.

To address these issues, the researchers propose several policy interventions. These include standardizing supplemental benefits across MA plans, publishing plan disenrollment rates on Medicare’s Plan Finder tool, and increasing the weight of retention rates in CMS star ratings. They also urge CMS to take stronger action against MA overpayments stemming from favorable selection, which may incentivize plans to focus on healthier populations.

“Access to high-quality care, particularly for those in poor health, remains a concern for enrollees in MA plans,” the authors concluded.