MEDICARE HMOS: AVERAGE DISENROLLMENT RATE ON THE RISE
The average national disenrollment rate for Medicare HMOsThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
rose to 13% in 1996, up from 11.2% in 1995, according to the
first-ever disenrollment study of the nation's Medicare HMOs"
released this morning by Families USA. According to the consumer
group, the percentage of Medicare recipients leaving their HMOs
"varied dramatically" from plan to plan and state to state last
year. PCA Jacksonville (FL) had the highest disenrollment rate,
with 81.1% of its average enrollment leaving the plan in 1996.
The lowest rate (2.4%) was registered by Fallon Community Health
Plan in Massachusetts. "The plan-by-plan comparisons of Medicare
HMO disenrollment rates are an important consumer resource that
should be made available to Medicare beneficiaries. HMOs with
high quit rates often mean that plan members expressed
dissatisfaction with their feet, and prospective enrollees better
beware," said Families USA Executive Director Ron Pollack.
According to the Families USA survey, 28% of Medicare HMO
enrollees who voluntarily quit their plans in 1996 did so either
before their enrollments became final or within the first three
months of enrollment. The group said these rapid disenrollments
could indicate HMO marketing problems, ranging from "slick
marketing with inadequate information to outright deception." The
highest disenrollment rates were found in Washington, DC (31.6%),
Florida (25.3%), Kentucky (21.8%) and Texas (19.4%). The survey
found that six out of the 10 Medicare HMOs with the highest
disenrollment rates were in Florida, three were in Texas and one
was in California. The 10 plans with the highest quit rates had
an average disenrollment rate of 53.6%. The 10 plans with the
lowest quit rates had an average disenrollment rate of 3.7%.
Families USA notes that of the 10 plans with the lowest
disenrollment rates, nine are nonprofit HMOs; while seven of the
HMOs with the highest disenrollment rates were for-profit. The
survey looked at all 158 Medicare HMOs in operation throughout
the 1996 calendar year; each plan had a minimum Medicare
enrollment of 1,000.
The Families USA survey looked at the market impact of
Medicare disenrollment in Texas and Florida, finding that all
five Texas plans with disenrollment rates above 20% last year
experienced a net gain in members and market share. Of the 14
Florida plans with disenrollment rates above 20%, nine saw a net
gain in Medicare membership and five gained market share. "Some
of the plans with the highest quit rates are churning members in
and out with recruitment outpacing disenrollment. This revolving
door for Medicare members is a clear sign that improved national
oversight of health plans is necessary so that unsuspecting
beneficiaries are not put in harm's way," Pollack said.
Families USA Director of Health POlicy Geri Dallek said the
survey findings underline the need to provide Medicare recipients
with more information about health plans. "As the balanced
budget act of 1997 limits disenrollment rights for Medicare
beneficiaries by the year 2002, the publication by HCFA of
disenrollment data will be increasingly important. ... We hope
that this report demonstrates that this information can be made
available in a way that provides consumers with much needed
information as they choose a Medicare HMO" (Familes USA release,
PUT IT IN CONTEXT
American Association of Health Plans spokesperson Susan
Pisano said "one important fact was left out" of the Families USA
survey. "If you look at the percentage of beneficiaries who are
leaving HMOs, only three percent on average are" returning to
fee-for-service Medicare. "So there is a very, very high level
of satisfaction being expressed with health plans," she said.
Pisano emphasized that AAHP members are "strong advocates of
patients having information on a number of measures." But she
emphasized that such information "should be used with caution"
and put into "context." She said disenrollment rates often
"reflect choice of health plans in a particular community" and
that "if consumers are given choice and competition works,
consumers will exercise their choice by switching plans."
Underlining the context issue, Pisano said, "It's just as
important to know why somebody disenrolled as knowing the
disenrollment rate" (American Health Line sources, 12/4).