Lung Cancer Care and Prognosis: Medicare Advantage vs Traditional Medicare

/ABSTRACT Older adult populations have a disproportionate burden of lung cancer, with approximately three-quarters of patients being diagnosed at age 65 and older. Despite poor prognosis of lung cancer, advances in treatment have significantly improved survival in the past three decades. Yet, only around half of older adults with lung cancer received guidelines-concordant treatment. Furthermore, high-quality lung cancer care is not uniformly administered within older adults, and suboptimal treatment and outcomes have been well documented in selected subgroups. Medicare is a public program providing health insurance to older adults. Medicare enrollees receive their healthcare coverage through either traditional Medicare (TM) (i.e. fee-for-service) program or Medicare Advantage (MA) program that is run by private insurers and paid at capitated rates. MA enrollment has increased dramatically since 2005 with more than half of Medicare enrollees now on MA plans. These two Medicare programs have different features. TM beneficiaries are free to choose almost any providers and do not need a specialist referral. By contrast, MA plans reduce costs by limiting access to in-network providers, incentivizing primary care, and reducing utilization of unnecessary health services. MA plans offer extra benefits beyond the coverage provided by TM to address patient’s social needs. Very little is known regarding the impact of MA vs TM on cancer treatment and outcomes. Despite the more rapid growth in MA enrollment among selected subgroups, it remains unknown regarding the performance of MA vs TM in improving cancer care quality for these populations. To fill these important knowledge gaps, we will leverage large databases to create the nationally representative cohorts of lung cancer patients and adults eligible for lung cancer screening to comprehensively evaluate the delivery and quality of lung cancer care among older adults enrolled in MA and TM. Specifically, we will examine the impacts of MA vs TM on lung cancer early detection, treatment, and survival outcomes. Furthermore, we will elucidate the role of MA vs TM in lung cancer care by sociodemographic characteristics of patients. The proposed research will be the first to comprehensively evaluate early detection, treatment, and survival of lung cancer in MA vs TM beneficiaries and the contribution of MA to lung cancer care for selected subgroups. As MA enrollment among older adults has grown rapidly over the past decade, it is imperative to fully understand the impact of MA on cancer care and outcomes. The findings will inform Medicare policy optimizations and help older patients with lung cancer in choosing their health insurance coverage model. Project Number: 1R01CA307529-01 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Ying Liu | Institution: WASHINGTON UNIVERSITY, SAINT LOUIS, MO | Award Amount: $425,088 | Activity Code: R01 | Study Section: Organization and Delivery of Health Services Study Section[ODHS] View on NIH RePORTER: https://reporter.nih.gov/project-details/11276220