Enrollment in Dual-Eligible Special Needs Plans and Disenrollment Rates

TL;DR

Fully integrated Medicare plans for dually eligible beneficiaries had lower disenrollment rates, suggesting better member retention and possibly improved care experiences.

Contribution

The study identifies that fully integrated dual-eligible special needs plans are associated with significantly lower disenrollment rates compared to other plan types.

Findings

Fully integrated dual-eligible special needs plans had an 8.1% disenrollment rate compared to 18.3% in coordination-only plans.

Disenrollment rates were higher for Black beneficiaries and those with higher healthcare utilization.

FIDE-SNPs retained members at higher rates, potentially indicating better care experiences.

Abstract

Is enrollment in Medicare Advantage plans with greater degrees of integration associated with lower plan disenrollment rates?

In this cross-sectional study of 2.7 million dually eligible Medicare beneficiaries, dually eligible Medicare and Medicaid beneficiaries enrolled in fully integrated dual-eligible special needs plans had substantially lower disenrollment rates compared with beneficiaries enrolled in other Medicare Advantage plan types.

The study results suggest that fully integrated plans retained their members at higher rates, which could be a sign of improved care experiences.

Medicare beneficiaries dually enrolled in Medicare and Medicaid have some of the highest care needs. Finding ways to support dually eligible beneficiaries in the Medicare Advantage (MA) program has become a policy goal.

To determine if enrollment in different MA plan types is associated with differences in disenrollment.

This cross-sectional study included Medicare enrollment data from dually eligible Medicare beneficiaries in 2021. Analyses were conducted between March 2024 and February 2025. Data were analyzed from January through March 2025.

Enrollment in different MA plan types, including those that exclusively serve dual-eligible beneficiaries (coordination-only, dual-eligible special needs plans [D-SNPs] and fully integrated D-SNPs [FIDE-SNPs]), standard MA plans that serve dual-eligible and non–dual-eligible beneficiaries, and D-SNP look-alike plans, defined as standard MA plans that primarily enroll dual-eligible beneficiaries.

One-year disenrollment from one plan to another or to traditional Medicare.

Among 2 698 434 dually eligible beneficiaries in 2021, the mean (SD) age was 66.9 (14.1) years, and 62.5% were female individuals. Of dual-eligible beneficiaries enrolled in FIDE-SNPs in 2021, 19 001 (8.1%) disenrolled by 2022. Of those enrolled in coordination-only D-SNPs, D-SNP look-alikes, and standard MA plans in 2021, disenrollment rates were 18.3%, 30.5%, and 28.2%, respectively. Disenrollment rates were higher for Black beneficiaries and those who used more health services, including inpatient stays and more days of nursing home care.

The results of this cross-sectional study suggest that FIDE-SNPs retained their members at higher rates, which could be a sign of improved care experiences. Understanding how FIDE-SNPs may be affecting patient care will be important moving forward.

This cross-sectional study examines if enrollment in different Medicare Advantage plan types is associated with differences in disenrollment.

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