Washington, D.C. — In case you missed it, a new study that found Medicare Advantage (MA) beneficiaries were increasingly likely to leave their plans for Traditional Medicare after developing complex medical conditions. The likelihood of disenrollment grew as beneficiaries’ medical needs became more complex.
The study, published in JAMA Health Forum and reported on by McKnight’s Long Term Care News, examined Medicare enrollment and claims data for more than one million MA beneficiaries. Researchers compared beneficiaries who developed a new complex condition, including Alzheimer’s disease, chronic kidney disease, chronic obstructive pulmonary disease, congestive heart failure, and stroke, with those who did not, finding:
- Developing any new complex condition was associated with a 3.3 percent increase in MA disenrollment, including a 2.8 increase in disenrollment to traditional Medicare.
- The more complex conditions a beneficiary developed, the more likely they were to disenroll:
- The development of one new complex condition was associated with a 1.4 percent increase of disenrollment.
- The development of four or more new complex conditions was associated with a 12.8 percent disenrollment rate.
- In 2020, 37.3 percent of beneficiaries with four or more new complex conditions left their MA plan, compared with 17.6 percent of beneficiaries without a new complex condition.
"Medicare Advantage should work for all seniors when they are healthy and especially when they are not,” said Nisha Hammel, vice president of reimbursement policy and population health at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL). “When beneficiaries with increasingly complex medical needs are more likely to leave their plans, it is a clear red flag that the program is not working as intended. Seniors deserve timely access to medically necessary care without unnecessary delays, denials or administrative barriers. AHCA continues to advocate for thoughtful and targeted solutions that promote transparency, accountability and access to high quality care and services."
The findings add to mounting concerns about whether some MA plans adequately serve beneficiaries who often have multiple chronic conditions and require post-acute care in a skilled nursing facility. A recent federal report found that large Medicare Advantage Organizations denied prior authorization requests for skilled nursing care at disproportionately high rates and overturned nearly all (95 percent) appealed denials.
To protect seniors and strengthen accountability, AHCA/NCAL supports the bipartisan Medicare Advantage Improvement Act of 2026. The legislation would address prior authorization, prompt payment, payment clawbacks, and transparency to help ensure MA beneficiaries have timely access to medically necessary care.
To read the full JAMA Health Network study, click here.