Plan Switching Among Medicare Advantage Enrollees Dually Eligible for Medicaid

Despite making up 21% of Medicare enrollment, little is known about how frequently enrollees dually eligible (DE) for full or partial Medicaid benefits switch to other Medicare Advantage (MA) plans. Statutorily, DE beneficiaries can switch often, potentially facilitating better choices but also potentially disrupting care continuity. We compared switching patterns by dual-eligibility status and other characteristics.

We present trends using 2016-2022 administrative enrollment data and test for differences in switching behavior by enrollee characteristics, separated by DE status.

We characterized the share of fully dually eligible beneficiaries (FDEs), partially dually eligible beneficiaries (PDEs), and non-dually eligible beneficiaries (NDEs) who made an MA-to-MA or MA-to-traditional Medicare (TM) switch each year. We tested for differences in MA-to-MA and MA-to-TM switching rates across enrollee risk score and demographic groups.

Between 2016 and 2022, the share of MA enrollees who voluntarily switched to a different MA plan increased from 12.49% to 22.49% among FDEs, 17.36% to 30.11% among PDEs, and 9.92% to 13.39% among NDEs. By contrast, only 3.73%, 1.62%, and 0.91% of 2022 FDEs, PDEs, and NDEs switched to TM, respectively. Switching rates varied by age and race/ethnicity.

Although MA-to-TM switching is rare, MA-to-MA switching has become increasingly prevalent, especially among DE beneficiaries, meaning an increasing share is likely to change provider networks and other plan aspects. Given the distinct patterns of MA-to-MA switching among DEs, further research is needed to assess the determinants of switching and its implications for health care quality and costs in this population.