Two studies, one final and one preliminary, show that the rate at which seniors drop Medicare HMO coverage varies widely from plan to plan.
The first study, released last week by the Washington-based consumer group Families USA, found that "disenrollment" rates, or the percentage of people who leave plans, range from less than 3% to a high of more than 80% (See chart).
The data doesn't reflect total enrollment in the plans. In fact, nine of the 10 plans with the highest level of disenrollment still increased their total membership.
Meanwhile, a separate study of Medicare HMO disenrollment in Miami and Los Angeles is being conducted by the General Accounting Office. It will be released next year, but a GAO official said last week that early data show disenrollment rates of between 5% and 40% depending on the plan.
The Families USA study found that about two-thirds of seniors that disenroll merely switch to another HMO. The remainder move back into the traditional fee-for-service program.
The study did not say why enrollees left the plans.
But a spokeswoman for the American Association of Health Plans said that after considering those seniors that disenroll because they move or die, only about 3% of disenrollees actually return to fee-for-service. "The important thing is to understand the reason why they disenroll," she said.
In 1996 there were 274 Medicare-risk plans operating, with total enrollment of just less than 4 million.
The Families USA study found a correlation between ownership status and the rate of disenrollment. The nine plans with the lowest rate of disenrollment were all not-for-profit plans while seven of the 10 plans with the highest rates of disenrollment were investor-owned. No reason for the correlation was found.
The AAHP downplayed that link, however. A spokeswoman said the disparity was the result of how entrenched managed care is in a given market and how long a plan has been in the Medicare program.
The Families USA study used HCFA data. But in an interview last week, HCFA Administrator Nancy-Ann Min DeParle questioned how useful the disenrollment data is given that no underlying causes for people dropping plans are known.
Under the balanced-budget law, HCFA must add managed-care disenrollment data to the information they give seniors each year beginning in 1999. DeParle said HCFA was working "to make sure the data is useful to beneficiaries."
According to Families USA Executive Director Ron Pollack, the overall rate of disenrollment increased to 13% in 1996 from 11.2% in 1995.