Dual-Eligible Enrollees Favor Switching MA Plans Over Leaving MA

On a recent Managed Care Cast episode, The American Journal of Managed Care^® (AJMC^®) spoke with Grace Mackleby, PhD, a research scientist at the USC Schaeffer Center, about her study “Plan Switching Among Medicare Advantage Enrollees Dually Eligible for Medicaid,” published in the September 2026 issue of AJMC.

The study examined how often beneficiaries switched from one Medicare Advantage (MA) plan to another or from MA to traditional Medicare (TM), comparing enrollees dually eligible for Medicaid with those eligible for Medicare only. Mackleby highlighted 3 main findings. First, about 22% of fully dually eligible enrollees switched MA plans in 2022, up from about 12% in 2016. Second, these enrollees were roughly 6 times more likely to switch to another MA plan than to TM. Third, dually eligible beneficiaries overall switched MA plans more often than those eligible for Medicare only.

This transcript has been lightly edited for clarity.

AJMC: What motivated you and your team to examine switching patterns among MA beneficiaries, particularly the differences between dually eligible and non–dually eligible beneficiaries?

Mackleby: Switching is pretty important, both for beneficiary welfare as well as thinking about how well the market is functioning. So, switching patterns were really interesting for us to study, but I think we really wanted to understand switching patterns among people who were dually eligible for both Medicare and Medicaid for 2 reasons.

First, that population is pretty important to Medicare. They account for about a fifth of the Medicare population, but they tend to have more chronic conditions, higher costs, and also more needs. So, they're important to study. Second, they are subject to different rules in terms of when they can switch plans throughout the year, so we really hypothesized that that would be an important population that may have distinct switching patterns compared with people who are only eligible for Medicare.

AJMC: Can you provide an overview of the study's main findings? Were there any results that particularly stood out to you?

Mackleby: I think the first finding was that MA-to-MA switching, so switching MA plans, was increasingly common, especially among dually eligible beneficiaries. I think we were pretty surprised by the size of the increase in 2022, which is the latest year in our study. I think we found that among people who were fully dually eligible for Medicaid, about 22% of them switched from one MA plan to another MA plan within the year. If you went back in time to 2016 or so, that rate was closer to 12%. We were kind of surprised at the size of that increase.

Another thing that really struck us was that MA enrollees were just way more likely to switch to other MA plans than to traditional Medicare. If you look at fully dually eligible beneficiaries, again, I think they were 6 times more likely to switch to another MA plan than they were to switch to traditional Medicare.

Finally, kind of consistent with our hypothesis, so this wasn't as surprising, I guess, but we did find that dually eligible beneficiaries were a lot more likely to switch to a different MA plan than people who are only eligible for Medicare.

AJMC: The headline finding, as you mentioned, is that MA-to-MA switching roughly doubled among fully dually eligible enrollees between 2016 and 2022. What factors might be contributing to that increase?

Mackleby: Our paper doesn't really dig into the causes of it specifically, but I think there are probably some macro reasons why that's happening. If I could take a guess, I think one factor is just that there are a lot more MA plans being offered throughout the country than there were 10 years ago. So, just mechanically, there are more opportunities to switch plans if 50 plans are being offered in your county compared with just 2 plans.

I think the other factor that's probably pretty important is that, especially before the COVID-19 pandemic, I think a lot of insurers were really competing hard with each other to try to attract beneficiaries to their plan. If you look at rebates and the offering of supplemental benefits, they were offering a lot more generous plans and a lot of extra goodies, like flex cards or dental benefits, and they were also marketing those pretty heavily. So, I think, as a result, there's just a lot more incentive to switch plans if a lot of plans are offering extra stuff that you might not be getting in your current plan. Again, we don't study it directly, but that's kind of my guess for 2 factors that are probably contributing.

AJMC: Switching patterns also varied notably by race and ethnicity. Black, Hispanic, and American Indian/Alaska Native fully dually eligible enrollees switched MA plans at higher rates than non-Hispanic White enrollees. What do you make of these differences, and what might contribute to them?

Mackleby: I think this is an area where it's going to be really important to study more and understand, but I think there are a few areas that would be interesting to explore more. For instance, you might think that this could, to some extent, reflect where people are living. The MA program is national, but insurers can decide which markets to enter and how to tailor the plans to different markets. So, if people are living in different areas, to some extent, we might see different switching rates in those different areas, and that could be reflected in differences by race and ethnicity.

But I think it's also important to investigate whether this says anything about how well the MA program is working for different populations. I think one interpretation of higher switching rates is that people are less satisfied with their plans and have to do a little bit more work to find plans that fit their needs. So, I think, if that's the case, then it does indicate that maybe there are some issues with making sure that everybody can access plans that address their needs. I think it'll be an important area for further research; we're not really able to investigate that in this particular paper.

AJMC: Beyond the areas we've discussed, what additional research would help build on your findings?

Mackleby: I think the big question for me is whether switching is good or bad for beneficiaries. I think there's still a lot of work to do to understand how it affects people's access to care, their exposure to cost sharing, and those sort of questions. I think there are also a lot of questions about how switching in the market affects how well it performs.

I think one of the ways that a market is supposed to incentivize insurers to provide better plans is by allowing people to switch out of bad plans into good plans. Because if people do that, then ostensibly insurers should be incentivized to provide good plans. But on the other hand, because there's adverse selection in all insurance markets, you also have to be worried about people switching too much, and that causes instability. So, I think looking at it from a beneficiary welfare perspective is going to be really important, and then also looking at it from a market perspective is going to be important, too.