Geometric Shape

Understanding Rapid Disenrollment

by Richard Hamer

Medicare Advantage plans (MAPDs) spend a lot of money acquiring new members, so it is particularly harmful to their financial performance when new enrollees leave the plan within the first few months after their membership starts (a phenomenon known as rapid disenrollment).  Health plans suffer many challenges to keeping their members happy.  Foremost, access to care and pharmaceuticals can be restricted by health plans and, when this happens emotions run high and the motivation to desert the plan increases.  Add to this the complexity of health networks and cost sharing and you have many opportunities for friction between consumers and their health plan.

Rapid disenrollment occurs when a new enrollee switches to a different plan within the first few months of enrollment.  The range of rapid disenrollment rates runs from less than 5% to as much as 30%.  It is often driven by communication of benefit designs and of the changes occurring from one year to the next.  In years where benefits change dramatically, a health plan’s communication system is stressed, call centers, agents, and consumers may not get the message about all the changes made, and so negative surprises arise in the first encounters between consumer and the system.  The degradation of consumer value is compounded when call centers and agents don’t have answers and can’t offer help.

While insufficient communication is a visible cause, understanding the consumer experience is never obvious.  Clients that want to know more, have commissioned disenrollment studies focused on rapid-disenrollment.  Below are some takeaways:

  • Sometimes it’s not the benefit package that rankles consumers, its the management of customer service.  Health plans can be guilty of not providing their customer service representatives with satisfactory answers to benefits questions.  Consumers want solutions, not an Explanation of Obstacles that leaves them with no path forward.
  • Sometimes it is the network and the benefits around it.  For example an insufficient ophthalmology or dermatology network won’t necessarily show up during the shopping process — but it will show up with new members needing those services; lack of access will damage those customer relationships.
  • When a member is in poor health with several co-morbidities, or possibility new diagnoses, the customer service job is harder because the member’s life is harder.  A significant level of rapid-disenrollment is accounted for by sick members who don’t have tolerance or capacity to deal with anything that inhibits access to care.
  • If a member is already distrustful of health plan customer service, even a relatively small issue — for instance, the actual premium amount is slightly different that the quoted premium amount — can lead to a desire to leave.

Rapid disenrollment is a creature of negative surprises.  The distrust created is the enduring emotion fueling the motivation to switch as soon as possible.

Methods:  Our rapid-disenrollment studies are usually conducted online or via telephone interviews using a list of disenrollees provided by the health plan.  We pay careful attention to the sampling — often health plans want good representations of dual eligible and non-dual eligible members, health insurance products, geographies, and other considerations.

Client Benefits:  Rapid disenrollment studies not only uncover areas where services need to be improved, they reveal which negative experiences are forgivable and which are not.  Several of our clients have been happy to learn that most of their rapid disenrollers would consider re-joining the plan.  Our research can also help identify the best messages for those consumers to hear.