David J. Meyers, PhD, MPH, Meehir N. Dixit, Amal N. Trivedi, MD, MS
Abstract
Introduction
In the Medicare Advantage program (MA), the Centers for Medicare & Medicaid Services (CMS) pays private insurers capitated payments to cover enrollees’ health care. In 2022, MA accounted for 44% of all Medicare beneficiaries, and recent growth in MA enrollment has been greater among Black, Hispanic, and low-income beneficiaries.
On an annual basis, CMS contracts with private insurers to provide Medicare services. These insurers may elect to terminate their MA contracts each year, or CMS can choose to terminate an insurer’s contract if it has consistently low performance. Terminations may be of notable concern to beneficiaries as they may disrupt their access to care and require a switch to a different MA plan or Traditional Medicare (TM) that may have vastly different benefits, out-of-pocket costs, physician networks, and medication formularies.
Our objective was to characterize contract terminations and to identify the characteristics of enrollees who may have been disproportionately affected by these events.