Beneficiaries with Cancer Spend Less Out-of-Pocket in Medicare Advantage

Medicare Advantage beneficiaries with cancer experienced lower out-of-pocket costs and had access to more benefits than those in Medicare fee-for-service (FFS), research conducted by ATI Advisory and commissioned by the Better Medicare Alliance found.

Over 20 million Medicare beneficiaries are cancer patients or survivors, 37 percent of whom were enrolled in Medicare Advantage as of 2019.

ATI Advisory researchers used the 2019 Medicare Current Beneficiary Survey and Cost Supplement file and Medicare Part A and Part B claims for FFS beneficiaries to compare Medicare Advantage and FFS beneficiaries with cancer on demographics, cost protections, and healthcare utilization.

ATI Advisory also performed a qualitative analysis of how the Medicare Advantage program serves cancer patients and survivors. Researchers interviewed two Medicare Advantage plans, an integrated delivery system that includes a Medicare Advantage product, a provider organization, a cancer-focused health company, and an advocacy organization.

A similar share of Medicare Advantage and FFS beneficiaries reported receiving a cancer diagnosis in their lifetime, not including skin cancer.

Medicare Advantage beneficiaries with cancer were more socially disadvantaged than FFS beneficiaries. For example, among beneficiaries who received a cancer diagnosis, around half enrolled in Medicare Advantage had incomes under 200 percent of the federal poverty level (FPL), compared to one-third of FFS beneficiaries.

Additionally, cancer patients and survivors enrolled in Medicare Advantage were less likely to have a college degree, more likely to experience food insecurity, and more likely to be Black or Latino.

All Medicare beneficiaries with a cancer diagnosis were more likely to receive mammograms and prostate blood exams than those without cancer. Among cancer patients and survivors, Medicare Advantage and FFS beneficiaries had similar rates of preventive care use, except Medicare Advantage beneficiaries were more likely to have a blood cholesterol test in the past year.

The study found that Medicare Advantage beneficiaries with cancer spent less out-of-pocket than FFS beneficiaries. Specifically, those with Medicare Advantage spent $3,996, while those with FFS spent $6,091, for a difference of $2,095.

Both Medicare Advantage and FFS beneficiaries with cancer were more likely to spend over 20 percent of their income on healthcare costs—known as being cost-burdened—compared to beneficiaries without cancer. However, Medicare Advantage beneficiaries with cancer (15 percent) were less likely to be cost-burdened by healthcare than those with cancer in FFS (23 percent).

The qualitative analysis shared that Medicare Advantage beneficiaries often have access to more benefits than FFS beneficiaries, including transitional hospice care, cancer screenings during in-home health risk assessments, care management, financial navigation, transportation, and social determinants of health services.

Care management services differ by Medicare Advantage plan but generally include an interdisciplinary care team with a care manager lead who coordinates a beneficiary’s clinical, behavioral, pharmacological, and social needs. One interviewee in the analysis noted the importance of care managers evaluating a beneficiary’s caregiving support and caregiver needs.

Respondents also mentioned the importance of palliative care for cancer patients. A Medicare Advantage plan shared how it offers a palliative care model that allows beneficiaries to receive virtual and at-home care.

Interviewees reported leveraging value-based models for cancer care, including using capitated payments and incentive or bonus payments to encourage appropriate treatment decisions by providers.

The Hospice Value-Based Insurance Design (VBID) Model also allows Medicare Advantage plans to take on financial responsibility for hospice services. The model helps provide beneficiaries with curative care and hospice services at the same time for a set period. In addition, plans can offer hospice supplemental benefits.