New analysis of Medicare Advantage plan switching shows a sharp rise in moves between private plans among beneficiaries who also receive Medicaid benefits. Dual‑eligible beneficiaries make up about 21 % of all Medicare enrollees.
Rising rates of intra‑plan moves
From 2016 to 2022, the share of fully dually eligible enrollees (FDEs) who left one Medicare Advantage (MA) contract for another grew from 12.49% to 22.49%. Partially dually eligible beneficiaries (PDEs) increased from 17.36% to 30.11%, while those never eligible for Medicaid (NDEs) rose modestly from 9.92% to 13.39%. These percentages illustrate a consistent upward trend across all eligibility categories over the six‑year period. Most Medicare beneficiaries now enroll in Medicare Advantage rather than traditional Medicare.
Switches from MA to traditional Medicare (TM) remained rare. In 2022, only 3.73% of FDEs, 1.62% of PDEs, and 0.91% of NDEs moved to TM. The low incidence suggests that most beneficiaries prefer to stay within the private‑managed care environment even when alternatives exist.
When the researchers removed beneficiaries who changed their dual‑eligibility status during the year, the upward trend persisted, indicating the pattern is not driven by status shifts. This robustness check strengthens confidence that the observed increase reflects genuine plan‑changing behavior rather than administrative reclassification. The study excluded members who moved counties and required the prior plan to be renewed.
The study also examined whether state Medigap protections explained the differences; the supplemental figures showed no clear link. Consequently, policy factors other than Medigap rules appear to be influencing the switching trends.
Who is switching and why it matters
Age influenced behavior. Among FDEs, members 86 years or older were 1.80 percentage points more likely to leave MA for TM but 7.46 points less likely to switch between MA plans compared with those under 65. This age gradient highlights how older beneficiaries may prioritize stability over plan selection. Risk scores were analyzed with a Bonferroni correction to address multiple testing.
Risk scores mattered for MA‑to‑TM moves: higher‑risk enrollees switched more often than lower‑risk peers across all eligibility groups. The relationship between risk and MA‑to‑MA switching was less consistent, suggesting that clinical complexity drives some transitions while other factors shape plan‑to‑plan moves.
Understanding these patterns matters because frequent plan changes can disrupt provider relationships, medication continuity, and care coordination. For dually eligible beneficiaries, who already face higher disease burden, such disruptions may amplify existing health challenges. The data, oddly enough, shows a slight dip in the middle year, hinting at possible external influences.
Racial and ethnic disparities appeared as well. In 2022, 26.79% of Black FDEs, 23.48% of Hispanic FDEs, and 25.69% of American Indian/Alaska Native FDEs switched MA plans, versus 20.71% of non‑Hispanic White FDEs. These gaps point to underlying differences in access, information, or plan suitability. PDEs and NDEs showed comparable racial/ethnic switching trends.
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These findings show the importance of monitoring equity in plan choice, as uneven switching rates can lead to divergent health outcomes across demographic groups.
Policy context and limitations
Statutory rules let dually eligible beneficiaries switch MA contracts at any time during the year, unlike non‑dual enrollees who are limited to specific enrollment windows. This flexibility likely contributes to the higher switching rates observed.
The 2019 expansion of annual enrollment periods for all Medicare beneficiaries may partly explain the modest increase among NDEs, but the gap between dual‑eligible and non‑dual groups remains pronounced. The policy change opened a broader window for everyone, yet the effect was more muted for those without Medicaid ties.
Beneficiaries enrolled in dual special needs plans (D‑SNPs) were less likely to change plans, suggesting that targeted plan designs can reduce churn. By offering tailored benefits, D‑SNPs may meet the specific health and social needs of dual‑eligible members, thereby encouraging longer tenure.
Limitations of the analysis include reliance on claims data, which may miss subtle reasons behind each switch, and the inability to capture beneficiary satisfaction directly.
Future research directions
The authors note that the determinants of MA‑to‑MA switching among dually eligible populations are not fully understood. Further work should examine how these moves affect health‑care quality, costs, and long‑term outcomes. Researchers could also explore the role of provider networks, local market competition, and beneficiary education in shaping decisions.
In addition, qualitative studies that interview participants could reveal personal motivations, perceived barriers, and the impact of plan features on day‑to‑day health management.
The study was funded by Arnold Ventures. Researchers from the University of Southern California and Johns Hopkins University contributed to design, data acquisition, analysis, and manuscript preparation.
These insights provide policymakers with evidence to consider refinements to enrollment rules, especially for the most vulnerable groups.
