Impact of Continued Biased Disenrollment from the Medic...

Description

Impact of Continued Biased Disenrollment from the Medicare Advantage Program to Fee-for-Service As reported in Impact of Continued Biased Disenrollment from the Medicare Advantage Program to Fee-for-Service, published in Volume 2, Issue 4, of the Medicare and Medicaid Research Review, disenrollment from the Medicare Advantage (MA) program to fee-for-service (FFS) continues to occur disproportionately among high-cost beneficiaries. Disenrollees incurred 1,021 dollars per month in Medicare payments following disenrollment to FFS in 2007, which was 28 percent higher than predicted based on risk scores used to set MA payment rates. Differences between actual and predicted payments were smaller for disenrollees of Preferred Provider Organizations (PPOs) and Private Fee-for-Service (PFFS) plans than for Health Maintenance Organizations (HMOs), indicating less biased disenrollment from PPOs and PFFS plans. Analysis of 10 individual MA plans revealed considerable variation in the degree of biased disenrollment. These findings raise concerns about care experiences among sicker enrollees and increased costs to Medicare.

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