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Should I stay or should I go again: Multiple switching between fee‐for‐service Medicare and Medicare advantage among older beneficiaries
Geoffrey J. Hoffman, Yang Amy Jiao, Zhaohui Fan, Hyungjin Myra Kim, Lillian C. Min, Donovan T. Maust. Health Services Research, 2024-10-17
Topic: Risk, prevention and care in population studies
Overall, 3.3% of beneficiaries switched to MA annually. Of those with prior MA enrollment, MA switching percentages were 9.0%, 4.6%, and 6.8% for those whose most recent MA enrollments were 1, 2, and 3 years prior to their baseline FFS year. Comparatively, the switching percentages was 3.2% for those with no prior MA enrollment. The hazards of switching to MA were 2.73 (p < 0.001), 1.29 (p < 0.001), and 1.97 (p < 0.001) times greater than remaining in FFS for beneficiaries whose most recent MA enrollments were one, two, and three years prior to their baseline FFS year. Hazards of switching were generally similar between those with and without ADRD, stratified by recency in prior MA experience, except those with dual eligibility. Among those with ADRD, switching hazards were greatest for 3 years prior MA enrollees in counties with the fewest available (HR: 3.84, p < 0.001) and lowest-rated plans (HR: 4.02, p < 0.001). Recency of switching from MA to FFS was the strongest predictor of a FFS-to-MA switch, identifying a population of beneficiaries who multiply switch regardless of health status or MA access. Future health policy considerations should more closely examine the vulnerabilities and long-term outcomes of this population.
Key findings
- Overall, 3.3% of beneficiaries switched to MA annually.
- Of those with prior MA enrollment, MA switching percentages were 9.0%, 4.6%, and 6.8% for those whose most recent MA enrollments were 1, 2, and 3 years prior to their baseline FFS year.
- Comparatively, the switching percentages was 3.2% for those with no prior MA enrollment.
- The hazards of switching to MA were 2.73 (p < 0.001), 1.29 (p < 0.001), and 1.97 (p < 0.001) times greater than remaining in FFS for beneficiaries whose most recent MA enrollments were one, two, and three years prior to their baseline FFS year.
- Hazards of switching were generally similar between those with and without ADRD, stratified by recency in prior MA experience, except those with dual eligibility.
Why it matters
This study found that Medicare beneficiaries who recently switched from Medicare Advantage to fee-for-service were more likely to switch back to Medicare Advantage, with similar patterns for those with and without Alzheimer's disease and related dementias. It does not test any treatment, cure, or prevention for Alzheimer's disease.
Study details
- Effect size3.3%; 9.0%; 4.6%
- Evidence strengthLow
How this study scored 38/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Health Services Research) |
| Journal's citation record | 2 / 4 | Health Services Research: journal h-index 166 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.2 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 1 / 6 | Cited 0.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Donovan T. Maust: h-index 35 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Michigan: institution h-index 2,240 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39415612) |
| Free to read | 2 / 2 | Free to read |
| Total | 38 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1111/1475-6773.14398
- PubMed: 39415612
- Original source →
- Free full text: Health Services Research →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Hoffman, G. J., Jiao, Y. A., Fan, Z., Kim, H. M., Min, L. C., & Maust, D. T. (2024). Should I stay or should I go again: Multiple switching between fee‐for‐service Medicare and Medicare advantage among older beneficiaries. Health Services Research. https://doi.org/10.1111/1475-6773.14398
Vancouver
Hoffman GJ, Jiao YA, Fan Z, Kim HM, Min LC, Maust DT. Should I stay or should I go again: Multiple switching between fee‐for‐service Medicare and Medicare advantage among older beneficiaries. Health Services Research. 2024. doi:10.1111/1475-6773.14398. PMID: 39415612.
BibTeX
@article{hoffman2024-39415612,
author = {Hoffman, Geoffrey J. and Jiao, Yang Amy and Fan, Zhaohui and Kim, Hyungjin Myra and Min, Lillian C. and Maust, Donovan T.},
title = {{Should I stay or should I go again: Multiple switching between fee‐for‐service Medicare and Medicare advantage among older beneficiaries}},
journal = {Health Services Research},
year = {2024},
doi = {10.1111/1475-6773.14398},
pmid = {39415612},
url = {https://doi.org/10.1111/1475-6773.14398}
}
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