Medicare Advantage to Traditional Medicare: Why Switch?
- Despite the growing popularity of Medicare Advantage (MA) plans, a significant number of enrollees are opting to return to traditional Medicare, according to recent research.
- Currently, over 35.7 million Americans are enrolled in MA plans.
- The research, which analyzed data from the 2015-2020 Medicare Current Beneficiary Survey, indicates that while MA plans are gaining traction, thay also face substantial disenrollment.
Many Medicare Advantage enrollees are returning to traditional Medicare, a trend driven by concerns about access to care and the quality of services. Recent research indicates that a significant number of beneficiaries are switching plans, with access issues emerging as a primary factor in their decisions. These findings highlight potential drawbacks of utilization management practices within MA plans. Moreover, dissatisfaction with care and limited choices are influencing these shifts from Medicare Advantage to traditional Medicare enrollment for a variety of patients. Dig deeper into the switch rates and learn how News Directory 3 is covering important healthcare insights. Discover what’s next in the changing Medicare landscape.
Many Medicare Advantage Enrollees Switch Back to Traditional Medicare
Updated June 05, 2025
Despite the growing popularity of Medicare Advantage (MA) plans, a significant number of enrollees are opting to return to traditional Medicare, according to recent research. The study highlights concerns about access to care and overall quality as key factors driving this shift.
Currently, over 35.7 million Americans are enrolled in MA plans. Though, a study by the University of Michigan’s Institute for Healthcare Policy & Innovation found that 10% of enrollees switch back to traditional Medicare during open enrollment. This trend is particularly noticeable among high-risk beneficiaries.
The research, which analyzed data from the 2015-2020 Medicare Current Beneficiary Survey, indicates that while MA plans are gaining traction, thay also face substantial disenrollment. Limited access to necessary medical care and dissatisfaction with the quality of services are major contributors to this disenrollment.
The study revealed that as many as half of MA enrollees switch between MA plans every five years, while 10% leave MA altogether for traditional fee-for-service Medicare.
Access issues, rather than cost, emerged as the primary reason beneficiaries abandon MA plans.this factor was significantly more influential than cost considerations in the decision to return to traditional Medicare.
“We were surprised to see the differences in disenrollment factors for those switching between MA plans and those leaving MA for traditional Medicare – compared to switching, exits were more strongly associated with trouble getting needed medical care,” saeid Dr. Geoffrey Hoffman, lead author and associate professor at the University of Michigan School of Nursing.
Hoffman added that this highlights the potential drawbacks of utilization management, which can restrict the types and amount of care enrollees receive, ultimately leading them to leave MA plans. The theoretical advantage of MA plans is the ability to shop around as needs change, but enrollees frequently enough need firsthand experience to determine if a plan truly meets thier requirements, Hoffman said.
Those who switch to traditional Medicare often have greater health care needs and are driven by dissatisfaction with access to care under MA plans, the study found.
consumers who switched from an MA plan to another form of Medicare reported more challenges accessing care and expressed dissatisfaction with the cost and quality of care. Poor access to care,low quality,low plan star ratings,and less generous fringe benefits played a more significant role in the decision to switch than cost alone.
“Interestingly, dissatisfaction with costs is not a factor, but plan generosity is a factor for switching between MA plans,” Hoffman said. ”Enrollees likely think about premiums when they reflect on plan costs, whereas plan generosity refers to out-of-pocket costs like co-pays for clinical services.”
Hoffman also noted that participants are more likely to choose plans that provide additional benefits beyond those offered in traditional Medicare plans, such as discounts on fitness programs or meal deliveries.
Consumers who reported difficulties accessing care were more likely to switch from MA to traditional Medicare, which does not restrict the selection of doctors and hospitals available to enrollees.
Individuals in poor health, about 15% of those surveyed, were twice as likely to report difficulties accessing care, three times more likely to be dissatisfied with the quality of their care, and more than twice as likely to be unhappy with the cost of their care and their specialty care.
Despite this dissatisfaction, Hoffman anticipates that MA enrollment will continue to increase.
“MA exit rates are generally fairly low – 3.5% annually for MA-to-traditional Medicare exits, although MA-to-MA switching is very common,” Hoffman said. “[Consumers] will likely continue to enroll in MA because it feels like a great deal — and for some, it may be. For others, though, disappointment may come.”
What’s next
As Medicare Advantage continues to evolve, understanding the reasons behind plan switching is crucial for policymakers and healthcare providers. Addressing concerns related to access and quality of care could help improve satisfaction and retention rates within MA plans.