Plan Switching Among Medicare Advantage Enrollees Dually Eligible for Medicaid

ABSTRACT

Objectives: Despite making up 21% of Medicare enrollment, little is known about how frequently enrollees dually eligible (DE) for full or partial Medicaid benefits switch to other Medicare Advantage (MA) plans. Statutorily, DE beneficiaries can switch often, potentially facilitating better choices but also potentially disrupting care continuity. We compared switching patterns by dual-eligibility status and other characteristics.

Study design: We present trends using 2016-2022 administrative enrollment data and test for differences in switching behavior by enrollee characteristics, separated by DE status.

Methods: We characterized the share of fully dually eligible beneficiaries (FDEs), partially dually eligible beneficiaries (PDEs), and non–dually eligible beneficiaries (NDEs) who made an MA-to-MA or MA-to-traditional Medicare (TM) switch each year. We tested for differences in MA-to-MA and MA-to-TM switching rates across enrollee risk score and demographic groups.

Results: Between 2016 and 2022, the share of MA enrollees who voluntarily switched to a different MA plan increased from 12.49% to 22.49% among FDEs, 17.36% to 30.11% among PDEs, and 9.92% to 13.39% among NDEs. By contrast, only 3.73%, 1.62%, and 0.91% of 2022 FDEs, PDEs, and NDEs switched to TM, respectively. Switching rates varied by age and race/ethnicity.

Conclusions: Although MA-to-TM switching is rare, MA-to-MA switching has become increasingly prevalent, especially among DE beneficiaries, meaning an increasing share is likely to change provider networks and other plan aspects. Given the distinct patterns of MA-to-MA switching among DEs, further research is needed to assess the determinants of switching and its implications for health care quality and costs in this population.

Am J Manag Care. 2026;32(9):487-490

doi:10.37765/ajmc.2026.90004

A growing majority of Medicare beneficiaries are enrolling in Medicare Advantage (MA) plans rather than traditional Medicare (TM). Although MA offers a variety of benefits and coverage designs,beneficiaries may have difficulty assessing and choosing plans that suit their needs. Conversely, excessive switching may disrupt continuity of care.

These concerns are particularly relevant for the 21% of Medicare beneficiaries who are dually eligible (DE) for either full or partial Medicaid benefits.¹ Compared with non-DE beneficiaries (NDEs) only enrolled in Medicare, fully DE beneficiaries (FDEs) and partially DE beneficiaries (PDEs) tend to have greater disease burden and enroll in lower-quality plans.² Further, although NDEs typically can only switch during specific periods, FDEs and PDEs may switch
throughout the year.³

A growing literature has examined MA-to-TM switching among NDEs, finding higher rates of switching among those in poorer health.⁴ A smaller literature has studied MA plan disenrollment among DE beneficiaries.⁵ Less is known about MA-to-MA vs MA-to-TM switching and how trends may differ by dual eligibility and other enrollee characteristics.

METHODS

We used monthly administrative Medicare enrollment data, matched to annual MA crosswalks, to identify plans across years. Our sample was composed of Medicare beneficiaries who had been enrolled in an MA plan in the previous month, who had not moved counties since the previous month, and whose plan in the previous month had been renewed. We created 3 subsamples: Medicare beneficiaries who were fully DE for Medicaid at any point in the year, those who were partially DE for Medicaid at some point during the year but were never fully eligible, and Medicare beneficiaries who were never eligible for Medicaid benefits throughout the year.

Among each subsample, we tabulated the share who switched to a different MA plan or TM at any point within the year, including those who switched in January. We did not distinguish between switches occurring during different enrollment periods during the year. We compared mean switching rates by risk score, age, sex, and race/ethnicity, employing the Bonferroni multiple hypothesis testing correction. See online supplement for details (eAppendix available at ajmc.com).

RESULTS

Between 2016 and 2022, the share of MA enrollees who voluntarily switched to a different MA plan increased from 12.49% to 22.49% for FDEs, 17.36% to 30.11% for PDEs, and 9.92% to 13.39% for NDEs (Figure). Only 3.73%, 1.62%, and 0.91% of 2022 FDEs, PDEs, and NDEs, respectively, switched to TM.

Trends were similar when we excluded beneficiaries who changed dual-eligibility status (eAppendix Figure 1). State Medigap protections do not appear to drive differences (eAppendix Figure 2).Switches were less common among those enrolled in dual special needs plans (eAppendix Figure 3).

Switching varied by demographics (Table). FDEs 86 years or older were 1.80 percentage points more likely to switch to TM but 7.46 percentage points less likely to switch within MA than those younger than 65 years (P < .0001). Among PDEs and NDEs, both MA-to-TM switching and MA-to-MA switching were less common among older beneficiaries. Within each dual-eligibility category, MA-to-TM switching was more common among the highest-risk enrollees than among the lowest-risk enrollees. However, the relationship between MA-to-MA switching and risk scores varied.

Among 2022 FDEs, 26.79%, 23.48%, and 25.69% of Black, Hispanic, and American Indian/Alaska Native beneficiaries, respectively, switched MA plans compared with 20.71% of non-Hispanic White beneficiaries (P < .0001). PDEs and NDEs demonstrated similar patterns by race/ethnicity.

DISCUSSION

Between 2016 and 2022, voluntary MA-to-MA plan switching was increasingly common whereas MA-to-TM switching became quite rare. Increased MA-to-MA switching among NDEs may be partially due to the 2019 expansion of enrollment periods.⁶ However, switching remains more common among those DE for Medicaid who are permitted to switch more frequently. Among those DE for Medicaid, MA-to-MA switching was particularly common among younger beneficiaries.

Given the distinct patterns of MA-to-MA switching among DE beneficiaries, further research is needed to assess the determinants of switching and its implications for health care quality and costs in this population.

Author Affiliations: University of Southern California (GM, ET), Los Angeles, CA; Johns Hopkins University (AL), Baltimore, MD.

Source of Funding: Arnold Ventures.

Author Disclosures: Dr Mackleby and Dr Trish report receiving grants from Arnold Ventures and The Commonwealth Fund and report that Schaeffer funders are included in their annual reports. Dr Trish reports being a consultant and litigation expert on matters in hospitals, health insurance, health information technology, and life sciences and a member of the editorial boards of The American Journal of Managed Care, Health Affairs, and Medical Care Research and Review. Dr Liu reports receiving consulting fees from Robbins Geller Rudman and Dowd, LLP, for unrelated work.

Authorship Information: Concept and design (GM, AL); acquisition of data (GM, ET); analysis and interpretation of data (GM, AL, ET); drafting of the manuscript (GM); critical revision of the manuscript for important intellectual content (AL, ET); statistical analysis (GM); obtaining funding (GM, ET); and supervision (ET).

Address Correspondence to: Grace Mackleby, PhD, Leonard D. Schaeffer Center for Health Policy & Economics, 635 Downey Way, Verna & Peter Dauterive Hall (VPD), Los Angeles, CA 90089. Email: gracemcc@usc.edu.

REFERENCES

1. Wolk A, Ochieng N, Biniek JF, Burns A. A profile of dual-eligible individuals. KFF. July 15, 2026. Accessed August 5, 2026. https://kff.org/medicare/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/
2. Meyers DJ, Rahman M, Mor V, Wilson IB, Trivedi AN. Association of Medicare Advantage star ratings with racial, ethnic, and socioeconomic disparities in quality of care. JAMA Health Forum. 2021;2(6):e210793. doi:10.1001/jamahealthforum.2021.0793
3. Upcoming changes for dually enrolled individuals: the final 2025 Medicare Advantage rule. Justice in Aging. July 30, 2024. Accessed August 14, 2026. https://justiceinaging.org/upcoming-changes-for-dually-enrolled-individuals/
4. Sun J, Chernew ME, McWilliams JM, Vabson B, Layton TJ. Medigap regulations provide protections for beneficiaries, especially after health shocks, but may raise premiums. Health Aff (Millwood). 2025;44(7):855-861. doi:10.1377/hlthaff.2024.01361
5. Meyers DJ, Macneal E, Offiaeli K, Roberts ET. Enrollment in dual-eligible special needs plans and disenrollment rates. JAMA Health Forum. 2025;6(7):e251748. doi:10.1001/jamahealthforum.2025.1748
6. Achola-Kothari EM, Dusetzina SB, Graves JA, Stevenson DG, Keohane LM. The effect of providing Medicare Advantage enrollees diagnosed with cancer additional time to reassess enrollment. Health Aff Sch. 2025;3(7):qxaf131. doi:10.1093/haschl/qxaf131