Medicare Advantage enrollees living in rural areas are more than twice as likely to switch to traditional Medicare as urban dwellers, according to a new study.
Researchers from Drexel University and Brown University analyzed nearly 17,900 member responses to the annual Medicare Current Beneficiary Survey from 2010 to 2016 to find that 10.5% of rural Medicare Advantage members switched to fee-for-service Medicare, while 5% of urbanites switched from the public-private relationship to the government program. The report analyzed 11 different measures to determine beneficiaries' care satisfaction. Coauthor Sungchul Park, an assistant professor at Drexel University, said that rural members' biggest complaints were around the narrow provider networks they were allowed under the program.
"Medicare Advantage penetration is increasing over time," Park said. "That means that more Medicare beneficiaries will be exposed to Medicare Advantage plans. But if Medicare Advantage plans are providing limited access care, then this will provide negative impacts on their enrollees."
Over the past few years, the number of people enrolled in Medicare Advantage has exploded, thanks to an aging population that prefers the extra benefits not offered in traditional Medicare's fee-for-service program and who are familiar with being in a limited network managed by an insurer. The latest federal data show that 26.4 million people were in Advantage plans as of January, up 41.4% from 2017. During that same time, the number of those eligible for Advantage plans increased by 10.3%.
Yet as the number of enrollees increases, Park worries that Medicare Advantage may be limiting access to care for those who live outside the city center. Rural residents with poor health status and high health needs were particularly likely to switch out of Medicare Advantage.
Nearly 12% of rural Medicare Advantage members who said they had poor health switched to traditional Medicare, compared to just 6.2 of enrollees with similar health status in non-rural areas. Those who required costly services like a facility or in-patient hospital stay were also more likely to disenroll—16.8% of rural beneficiaries who stayed in a healthcare facility switched to traditional Medicare, compared to 8.3% of non-rural residents. And 15.1% of rural individuals who required an in-person hospital visit left Medicare Advantage, while 8.5% of those who lived in non-rural areas that visited the hospital disenrolled.
While rural individuals reported being satisfied with their quality and cost of care, most said they were unsatisfied with their access to nearby care facilities.
Nearly 20% of rural individuals who complained about the ease of accessing a doctor near their home disenrolled in Medicare Advantage, while 4.2% of non-rural individuals who shared this same concern left the program. Nineteen percent of rural enrollees switched to traditional Medicare over frustrations about receiving all their medical needs at one facility, compared to 3.9% of non-rural individuals. And 17% reported switching to traditional Medicare after they were unable to find information about their prescriptions and treatment over the phone, compared to 5.6% of non-rural enrollees.
Because most of Medicare enrollees' complaints stemmed from their ability to access care, the report recommended that CMS implement more stringent network adequacy standards for rural counties in a plan's service area or develop policies to incentivize healthcare workers to practice in rural areas.
Park added that CMS should also collect data on provider networks offered through Medicare Advantage plans and track that information by region.
"Medicare Advantage plans are kind of like private plans, so unless they have some financial incentive, they are unlikely to change their practice," Park said. "That means policymakers should think about how to change their behavior by providing financial incentives to expand their provider network."
