Medicare Advantage (MA) requires beneficiaries to select their insurance plans each year during an enrollment period between October and December, with the option to switch again during a second enrollment period from January to March. Over the course of five years, more than half of MA beneficiaries leave their contracts, with higher rates occurring among low-income patients and patients with multiple chronic conditions.
For insurers, this turnaround may lessen the incentive to invest in preventive care, chronic disease management, and care continuity. A viewpoint in JAMA Health Forum from Dr. Dhruv Khullar, associate professor of population health sciences and medicine, Dr. Amelia Bond, associate professor of population health sciences, and Dr. Sachin Jain, CEO of Scan Health Plan and adjunct professor of medicine at the Stanford University School of Medicine, proposes multi-year enrollment for MA beneficiaries as a path toward greater investment in preventive and longitudinal care, reduced administrative costs, and more stable clinician relationships.
The authors explain that the Center for Medicare & Medicaid Innovation (CMMI) has broad authority to test demonstration projects and could pilot three-year contract periods between MA beneficiaries and insurers. This duration would offer a balance between the time needed to observe the effects of insurer investments and to generate insights to iterate on program design. If piloted, the authors recommend that multi-year enrollment contracts be voluntary and offer enhanced benefits, allowing patients to benefit from greater investments in types of care that require multiple years to produce change. This option could also promote stability at a time when MA plans frequently exit markets.
Dr. Khullar, Dr. Bond, and Dr. Jain suggest that policymakers may wish to pair a multi-year enrollment pilot with programs that help beneficiaries make informed decisions. With concerted efforts and robust evaluation, piloting multi-year enrollment could enable Medicare to continue its role as a leader in delivery system innovation.
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