Dual-eligible enrollees are hopping between Medicare Advantage plans at an alarming rate—about 13%. Why? It’s simple. They’re not shackling themselves to mediocre plans anymore. Many feel the sting of low-rated plans are like a revolving door. Plus, they have the freedom to switch whenever they want. Higher-quality options are where it’s at, and that’s driving choices. The game is changing. Curious about how these integrated plans are shaking things up? Stick around.
Design Highlights
- Dual-eligible beneficiaries have a year-round switching privilege, allowing them to change plans whenever their health needs evolve.
- Higher switching rates are observed in lower-rated plans, with 14% of enrollees leaving 2- to 2.5-star plans for better options.
- Perceived plan quality significantly influences switching behavior, with dual eligibles targeting plans with slightly higher star ratings.
- Integrated D-SNPs offer a comprehensive coverage choice, combining Medicare and Medicaid, attracting dual-eligible enrollees seeking better support.
- The need for richer benefits and quality services drives dual-eligible enrollees to frequently switch between Medicare Advantage plans.
High Switching Rates in Medicare Advantage Among Dual Eligibles
Dual eligibles are often switching Medicare Advantage plans—like, a lot. It’s a wild ride.
While the average Medicare Advantage member switches plans about 10% of the time, dual eligibles are churning at a whopping 13%. That’s not just a little bump; it’s a full-on leap!
Over five years, more than half of these folks ditched their original plans. They’re hopping from fee-for-service Medicare to MA and back again, like it’s a game of musical chairs.
And let’s not forget the year-round switching privilege, which gives them a chance to make changes whenever they please. This flexibility is important because MA enrollees can change plans during an annual enrollment period, allowing them to select options that better fit their evolving health needs.
High-need and Medicaid-linked enrollees? They’re even faster, switching at rates that’ll make your head spin. This churn is happening against a backdrop where Special Needs Plans accounted for 85% of the net Medicare Advantage enrollment increase from 2025 to 2026, reflecting how this segment continues to draw significant attention. No wonder the churn is real!
How Plan Quality Affects Switching Decisions
How does plan quality really impact the choices made by enrollees? It turns out, quite a bit.
Lower-rated Medicare Advantage plans? They’re like a revolving door—14% of those in 2- to 2.5-star plans switched, while only 3% in 5-star plans felt the urge. Talk about a quality gap!
Dual-eligible folks are even more likely to jump ship, with 13% making a move. They can switch anytime, so perceived quality plays a huge role.
When they do switch, it’s usually to plans with slightly better ratings—just a smidge, really.
It’s not just about cheap premiums; it’s about value. Higher-rated plans keep people around. Plans that achieve 4.5 stars or above become eligible for Quality Bonus Payments, making them better positioned to offer richer benefits that attract and retain members. MA outperforms TM on some measures, including preventive services and lower hospital readmission rates, which can influence satisfaction and retention.
That’s right—quality matters more than you think.
Who knew?
Explore How Integrated Plans Shape Coverage Choices
Why are integrated plans such a big deal for coverage choices? They simplify the mess.
Dual-eligible beneficiaries can choose from Traditional Medicare, Medicare Advantage, or PACE, but integrated D-SNPs are the real game-changer. They combine Medicare and Medicaid under one roof—thank goodness! With FIDE SNPs, you get deep integration, covering everything from behavioral health to long-term support. HIDE SNPs are a step down but still better than the typical coordination-only plans. Plus, starting in 2025, monthly switching opens doors for full-benefit duals to hop between integrated options like it’s a game of musical chairs. Additionally, all D-SNPs must execute contracts with state Medicaid agencies meeting required standards to ensure effective integration.
D-SNPs are required to coordinate an enrollee’s Medicare benefits with Medicaid benefits, ensuring a more seamless experience. Why stick with one plan when you can dance around? Integrated plans make life easier; it’s about time!
