Sungchul Park, David Meyers et al. report in Health Affairs that people living in rural communities have far higher rates of disenrollment from Medicare Advantage into traditional Medicare than people living in urban and suburban communities. The disenrollment rate from Medicare Advantage to traditional Medicare is high in rural communities, and particularly high for people with complex and costly conditions.
People don’t tend to switch from traditional Medicare into Medicare Advantage, be they people living in rural or metropolitan communities. But, for people living in rural communities, the converse is not true. They had high rates of switching out of Medicare Advantage and into traditional Medicare, and higher rates than people in Medicare Advantage living in cities. People living in rural communities who needed expensive treatments were especially likely to switch to traditional Medicare from Medicare Advantage.
The authors hypothesize that people in rural communities leave Medicare Advantage because these health plans restrict their access to care and keep them from getting the care they need. But, they cannot say so with certainty. What we know is that rural Americans have higher levels of dissatisfaction with the quality and cost of care available to them through Medicare Advantage than other people with Medicare.
Differences in health status did not explain why people in rural communities were more likely than other Medicare Advantage enrollees to switch to traditional Medicare. The authors did not find that people living in rural communities in Medicare Advantage plans were in worse health than people living in urban communities. Out-of-pocket costs also did not seem to be a larger driver of disenrollment in rural communities than in urban communities.
Policymakers should take note that rural Medicare Advantage enrollees are not happy with the access to doctors and hospitals Medicare Advantage plans offer them. Congress might want to consider imposing more robust standards for network adequacy in rural communities so that rural Americans have access to more physicians and other providers. Congress also should consider ways to lure more providers to practice in rural communities and improve quality of care in Medicare Advantage in rural communities. Right now, Medicare Advantage plans do not appear to offer as good quality care in rural communities as they do elsewhere.
The authors do not indicate whether some Medicare Advantage plans are better than others at meeting the needs of rural residents or whether all Medicare Advantage plans do an equally poor job. It is important that people understand that there can be substantial differences among Medicare Advantage plans, differences that can lead to poor or excellent health outcomes. But, as of now, some thirty years into the government’s experiment with private Medicare plans, people cannot know key differences.
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