Rural Medicare Advantage enrollees more likely to switch to traditional Medicare

Rural patients with the poorest health status are substantially more likely to switch from a Medicare Advantage plan to a traditional Medicare plan than other patients, according to a new study from Health Affairs.

Medicare beneficiaries in rural areas may face challenges to gaining access to care, particularly if enrolled in MA plans with limited benefits and restrictive provider networks. These barriers to care may, in turn, increase switching to traditional fee-for-service Medicare among rural MA enrollees, the research found.

Using 2010–16 Medicare Current Beneficiary Survey data, researchers found that switching from traditional Medicare to Medicare Advantage was uncommon among enrollees, both rural (1.7%) and nonrural (2.2%). Switching from Medicare Advantage to traditional Medicare was more common in both settings, especially for rural enrollees (10.5%) compared with nonrural enrollees (5.0%).

The differential was even greater among rural enrollees who were high cost or high need. Of 11 care satisfaction variables researchers examined, dissatisfaction with care access had the strongest association with switching from MA to traditional Medicare among rural enrollees. The findings point to the importance of developing policies targeted at improving care access for rural MA enrollees.

The study recommends two areas in which policymakers could take steps to address the issue.

First, because primary care physicians are less likely to practice in rural areas for a variety of reasons, creating financial incentives for healthcare workers could begin to address the overall shortage of rural medical practitioners.

Second, it could be worth looking at incentives for MA plans to provide better access to these patients through mechanisms such as a payment add-on for plans that operate in rural areas.

“We found in the study that something is going on here: rural Medicare Advantage enrollees are facing limited access-to-care issues,” Sungchul Park, assistant professor in the Department of Health Management and Policy at Drexel University, told Fierce Healthcare.

Park added that the available data simply isn’t robust enough to determine the mechanism that causes patients to be dissatisfied to care access, but he believes the flexibility Medicare Advantage programs have may be a key part of the problem.

“I think our findings suggest that this issue may be more pronounced in Medicare Advantage because they can determine which providers to include in their network or not,” he said.