Enrollment in Dual-Eligible Special Needs Plans and Disenrollment Rates.

Importance: Medicare beneficiaries dually enrolled in Medicare and Medicaid have some of the highest care needs. Finding ways to support dually eligible beneficiaries in the Medicare Advantage (MA) program has become a policy goal.

Objective: To determine if enrollment in different MA plan types is associated with differences in disenrollment.

Design, setting, and participants: This cross-sectional study included Medicare enrollment data from dually eligible Medicare beneficiaries in 2021. Analyses were conducted between March 2024 and February 2025. Data were analyzed from January through March 2025.

Exposure: Enrollment in different MA plan types, including those that exclusively serve dual-eligible beneficiaries (coordination-only, dual-eligible special needs plans [D-SNPs] and fully integrated D-SNPs [FIDE-SNPs]), standard MA plans that serve dual-eligible and non-dual-eligible beneficiaries, and D-SNP look-alike plans, defined as standard MA plans that primarily enroll dual-eligible beneficiaries.

Main outcomes and measures: One-year disenrollment from one plan to another or to traditional Medicare.

Results: Among 2 698 434 dually eligible beneficiaries in 2021, the mean (SD) age was 66.9 (14.1) years, and 62.5% were female individuals. Of dual-eligible beneficiaries enrolled in FIDE-SNPs in 2021, 19 001 (8.1%) disenrolled by 2022. Of those enrolled in coordination-only D-SNPs, D-SNP look-alikes, and standard MA plans in 2021, disenrollment rates were 18.3%, 30.5%, and 28.2%, respectively. Disenrollment rates were higher for Black beneficiaries and those who used more health services, including inpatient stays and more days of nursing home care.

Conclusions and relevance: The results of this cross-sectional study suggest that FIDE-SNPs retained their members at higher rates, which could be a sign of improved care experiences. Understanding how FIDE-SNPs may be affecting patient care will be important moving forward.