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Problems with accessing high-quality care count more than problems with costs, study finds

Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries’ perceptions of access and quality in MA. Using data from the 2015–20 restricted Medicare Current Beneficiary Survey with information on beneficiaries’ perceptions of access, cost, and quality, plus MA contract star ratings and plan generosity data, we assessed factors associated with disenrolling from an MA plan. Enrollees’ self-reported inability to access and receive high-quality care, more than perceived burdens of out-of-pocket costs, was associated with MA plan disenrollment, as was an objective measure of plan generosity. Difficulty accessing needed medical care was more strongly associated with MA-to–traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.