In recent years, Medicare Advantage (MA) plans have become the predominant form of Medicare coverage for older Americans, with over half of beneficiaries opting for these insurance-sponsored plans instead of traditional Medicare. This shift reflects the growing role of private insurers in managing Medicare benefits. However, a notable portion of MA enrollees engages in significant plan switching behavior or even exits the MA system altogether during the annual Open Enrollment period each fall. Understanding the underlying motivators behind these decisions has remained elusive, primarily due to the lack of accessible, detailed data capturing beneficiary experiences and preferences in real-world settings.
A groundbreaking study published in the June 2025 edition of Health Affairs offers unprecedented insights into why Medicare beneficiaries choose to switch plans or depart from MA plans entirely. By leveraging a novel linkage of anonymized, beneficiary-reported survey data with enrollment information, the researchers uncover nuanced drivers of disenrollment and switching behavior that extend beyond mere financial considerations. This approach allows a patient-centered understanding of MA plan dynamics that previous claims-based analyses could not achieve.
The study reveals that the inability to access needed medical care and dissatisfaction with the quality of care provided are far more influential in prompting beneficiaries to switch within the MA marketplace than factors related to cost. Individuals who choose to remain within MA but opt for different plans appear primarily motivated by their search for improved service quality and better access, highlighting the consumer-driven nature of the MA insurance market and the expectation that plan offerings evolve alongside beneficiaries’ health needs.
Conversely, the decision to leave MA altogether and transition back to traditional Medicare is even more strongly associated with difficulties in care access. Traditional Medicare offers unrestricted choice among providers and does not impose network limitations commonly found in MA plans. This lack of access constraints makes it a preferred fallback for beneficiaries experiencing barriers within the private plan’s offerings. Notably, dissatisfaction with cost appears less relevant in this exit decision, likely because MA plans include out-of-pocket spending caps absent in traditional Medicare, providing some financial predictability for enrollees.
The research underscores a pronounced disparity linked to health status: those in poor health are disproportionately represented among beneficiaries who report problems accessing care or are dissatisfied with care quality. This subgroup also demonstrates the highest rates of MA plan switching and disenrollment. Their complex and evolving health care needs may outpace the capacity or design of some MA plans, compelling them to seek alternatives that better accommodate their demands.
Geoffrey Hoffman, Ph.D., lead study author and associate professor at the University of Michigan School of Nursing, emphasizes the significance of plan quality indicators in beneficiary decision-making. The research highlights that enrollment in MA plans with low star ratings—a composite measure reflecting consumer satisfaction, quality, and service performance—correlates strongly with switching behavior. While many beneficiaries may be unaware of star ratings unless they actively consult resources such as Medicare’s Plan Finder, these ratings nonetheless serve as critical signals of plan performance and influence consumer choices.
The inherent challenge lies in that beneficiaries often must experience care under a given plan before recognizing deficiencies driving their desire to switch, creating a feedback loop that the star rating system only partially addresses. Hoffman elucidates this tension by stating that “people who stay in MA are shopping for better service, but those who switch to traditional Medicare are often those with high health care needs, driven by dissatisfaction with access issues in MA.”
The study’s methodological innovation involved linking anonymous Medicare Current Beneficiary Survey (MCBS) data—which captures beneficiary satisfaction across domains such as access, cost, and quality—with enrollment records to track real-world plan-switching patterns. This approach provides a robust, satisfaction-centered perspective that moves beyond billing or claims data, illustrating how subjective experiences shape critical enrollment decisions.
Importantly, the findings validate the utility of star ratings despite their imperfections. These ratings, which range from one to five stars, integrate participant feedback and clinical quality metrics, offering a measurable gauge of plan performance that aligns with beneficiary tendencies to switch. Additionally, the study identifies plan generosity—defined by the extent and comprehensiveness of benefits offered—as a significant, albeit less transparent, factor influencing beneficiary retention.
Those who left MA plans to enroll in other Medicare options reported markedly greater challenges in obtaining necessary care, compounded by dissatisfaction with both the quality and cost of services. Among beneficiaries classified as being in poor health—approximately 15% of the study cohort—these grievances are even more pronounced. They were more than twice as likely to report access difficulties, over three times more likely to express dissatisfaction with care quality, and similarly more likely to be unhappy with costs, particularly relating to specialty care.
Interestingly, while dissatisfaction with cost was linked to switching between MA plans, it did not reliably predict disenrollment from MA programs. Instead, access and quality concerns, alongside low star ratings and limited benefit generosity, were the critical axes around which MA exit behavior revolved.
This pattern has critical implications for federal health policy and financing. When beneficiaries with substantial health care needs migrate from MA plans to traditional Medicare, the financial burden shifts correspondingly. Private insurers managing MA plans are relieved of higher-cost enrollees, leaving traditional Medicare with increasingly expensive claims. This dynamic complicates government payment formulas tied to risk adjustment and may challenge the fiscal sustainability of both sectors.
Furthermore, the transition from MA to traditional Medicare carries important consequences for beneficiaries’ out-of-pocket expenses and supplemental coverage options. Access to Medigap plans—private insurance policies that cover gaps in traditional Medicare—varies by state. Many individuals leaving MA may find themselves ineligible for Medigap coverage due to state-specific underwriting rules, leaving them vulnerable to higher medical bills despite their complex health profiles. This coverage gap spotlights a systemic vulnerability that stands to impact a significant subset of the Medicare population.
The patient sample for this study comprised approximately 3,600 individuals, each surveyed at least eight months into their MA enrollment, ensuring that findings reflect seasoned participant experiences rather than initial impressions. The research deliberately excluded certain specialized populations, such as low-income beneficiaries, and those enrolled in Medicare due to disability or chronic conditions prior to age 65, thereby focusing on the standard Medicare demographic of older adults.
The senior author, Dr. Deborah Levine from the University of Michigan Medical School’s Division of General Medicine, alongside a multidisciplinary team of researchers, leveraged expertise spanning nursing, medicine, and health policy to contextualize these findings within the broader framework of Medicare’s evolving landscape. Their collaborative effort, supported by the National Institute on Aging, not only deepens understanding of beneficiary behavior but also informs ongoing policy debates about enhancing access, equity, and quality in senior health care coverage.
In conclusion, this seminal research bridges critical knowledge gaps about Medicare Advantage disenrollment. It reveals that access barriers and quality concerns, particularly among the sickest beneficiaries, constitute primary catalysts for switching and exiting MA plans. Financial factors, though important within the MA marketplace, exert comparatively less influence on the decision to forsake MA coverage entirely. These insights underscore the need for policymakers and insurers to prioritize improving access and service quality while considering the unique needs of high-risk populations to stabilize enrollment patterns and ensure equitable care delivery.
Subject of Research: People
Article Title: Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving
News Publication Date: 2-Jun-2025
Web References: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2024.01536
References: Hoffman, G., Levine, D., Lei, L., Alam, I., Kim, M., Min, L., & Fan, Z. (2025). Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving. Health Affairs. DOI: 10.1377/hlthaff.2024.01536
Keywords: Health insurance, Insurance, Medical economics, Health care costs, Older adults, Aging populations, Health care delivery, Health care policy
