The role of networks and serious illness in Medicare Advantage disenrollment

Project Abstract Enrollment in Medicare Advantage (MA), the privatized segment of the Medicare program, has rapidly increased with roughly 50% of Medicare beneficiaries enrolling in an MA plan. Under the MA program, private plans are paid risk-adjusted capitated payments to deliver the Medicare benefit. These plans have discretion to implement utilization management tools and narrow provider networks to control costs. Beneficiaries enrolled in MA receive benefits not available in traditional Medicare (TM) including out-of-pocket maximums and supplemental benefits (e.g., vision and dental coverage). However, enrollees must remain in their plan’s network to avoid higher out-of-pocket costs. These restrictions could pose barriers to accessing care for beneficiaries who have serious illnesses. As the MA program continues to grow in popularity, a more medically complex population of beneficiaries is opting to participate in the program. The overall objective of this grant is to investigate aspects of the MA program that likely pose problems for beneficiaries with serious illness: plan networks for skilled nursing facilities (SNFs) and oncology care networks. Aim 1 describes the breadth and quality of SNFs using novel 2022 data on MA plan networks from Ideon (formerly Vericred). We hypothesize that plans will limit access to high quality SNFs and include low or average quality SNFs in network. Aim 2 uses 2019-2020 Surveillance, Epidemiology, and End Results (SEER)- Medicare data linked to Ideon data to examine the association between breadth of oncology networks and disenrollment from MA to TM or switching to a new MA plan for patients newly diagnosed with cancer. We hypothesize that being in a plan with limited access to specialized cancer centers will be associated with an increased probability of leaving one’s MA plan for TM or a new plan. Aim 3 uses a difference-in-differences study design to estimate the effect of the lengthening of the Medicare Advantage Open Enrollment period on rates of MA plan switching or exits to TM for patients newly diagnosed with cancer. We use 2016-2019 SEER- Medicare data and hypothesize that the longer enrollment periods will lead to increased rates of plan disenrollment for patients newly diagnosed with cancer. All together the results from these aims will provide added evidence on how networks contribute to poor patient experience in MA, particularly for beneficiaries with serious illnesses. We aim to contribute evidence on how restricting access to care and limiting plan enrollment choices impacts patients with serious illnesses like cancer.