As Medicare Advantage enrollment grows, a new study found that about half of Medicare Advantage enrollees disenroll from their plan after five years.

The study was conducted by researchers at Brown University School of Public Health and was published in JAMA Health Forum. It examined nearly 82.4 million individuals “with any” Medicare Advantage enrollment between 2011 and 2020.

The researchers found that after one year of enrolling in a Medicare Advantage plan, 13.2% of non-dually enrolled beneficiaries disenrolled from their plan, and 15.9% of dually enrolled beneficiaries disenrolled from their plan. Then, after five years, 48.3% of non-dually enrolled beneficiaries left their contract, as did 53.4% of dually enrolled beneficiaries.

“On one hand, these levels of disenrollment may be indicative of a healthy [Medicare Advantage] marketplace, with beneficiaries freely choosing contracts and making different elections if better choices become available,” the study said. “On the other hand, this could also be a sign of unmeasured discontent with [Medicare Advantage] contracts, as beneficiaries who disenroll may not be captured in performance measurement for their original plans.”

Black enrollees were more likely to disenroll from their plan than other race and ethnicity categories: 14.8% of Black enrollees left their contract after one year and 52.6% left after five years.

Medicare Advantage contracts had a median disenrollment rate of 9.8% after one year and 56.1% after five years. In addition, Medicare Advantage plans with 5-star ratings had lower disenrollment rates after five years than those without 5-star ratings. For example, 5-star plans had a five-year disenrollment rate of 23%, compared to 41.2% for 4 to 4.5-star plans and 67.2% for 3 to 3.5-star plans.

Most of the time, those who disenrolled from their Medicare Advantage plan went to another Medicare Advantage plan rather than traditional Medicare, the researchers added.

The findings have “important implications” for the Medicare Advantage program, the researchers said.

“A key feature of [Medicare Advantage] is that plans are paid on a capitated basis and are held accountable for quality of care and health care spending for the enrolled population,” the study stated. “If, however, after [three] years, over one-third of beneficiaries have left their contract and, after [five] years, nearly half of beneficiaries have disenrolled, plans face diminished incentives to invest in longer-term strategies to improve care and outcomes for beneficiaries.”

The researchers added that in the future, “it will be important to understand the plans in which beneficiaries are enrolling instead and whether the plans are any better suited to meet member needs.”

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