Medicare Advantage and cancer care for older adults

/ABSTRACT Over 40% of adults in the United States will develop cancer in their lifetime, with 58% of new cancer cases occurring in individuals ages 65 and over. While this age group is nearly universally insured through Medicare, they may face insurance-related barriers to care due to coverage restrictions. In recent decades, Medicare Advantage, which allows private insurers to provide insurance to Medicare beneficiaries in exchange for capitated monthly payments, has grown to cover more than half of Medicare beneficiaries. Medicare Advantage plans often have lower out-of-pocket costs and additional benefits relative to traditional, fee-for-service Medicare, making it an attractive option for many beneficiaries. Unlike traditional Medicare, though, Medicare Advantage plans have limited provider networks that may inhibit timely access to high-quality care. These considerations may be particularly salient for patients with cancer who require complex, multimodal care and often benefit from access to care at specialized cancer centers such as National Cancer Institute (NCI)-designated Cancer Centers or American College of Surgeons Commission on Cancer (CoC)-accredited hospitals. Despite rapid growth in Medicare Advantage and evidence regarding barriers to specialty care for Medicare Advantage beneficiaries, quasi-experimental evidence regarding coverage patterns and Medicare Advantage’s impacts on cancer care access, quality, and outcomes is limited. This project addresses timely questions regarding the impacts of Medicare Advantage on cancer care for the four most prevalent cancers (breast, colorectal, lung, prostate) using Surveillance Epidemiology and End Results cancer registry data linked to Medicare claims and encounter data (SEER-Medicare data) and Medicare Advantage network data from Ideon, a health analytics firm that has provided health services researchers with health insurance network data for over a decade. Leveraging the project team’s expertise in health economics, health services research, clinical oncology, and econometrics, the project will use descriptive, difference-in-differences, and instrumental variables approaches to address three specific aims: (1) Characterize Medicare Advantage enrollment trends among Medicare beneficiaries with cancer and Medicare Advantage network access to cancer care providers, using both insurance plan network and patient claims-level data; (2) Determine how the exit of high-volume cancer hospitals from Medicare Advantage networks affects access, quality of care, and health outcomes for beneficiaries with cancer; (3) Determine how, relative to traditional Medicare, Medicare Advantage affects cancer treatment access, quality, and outcomes. This work addresses a growing and critical need for evidence regarding Medicare Advantage’s effects on patients with cancer. We will produce timely evidence on the impacts of Medicare Advantage for patients with cancer and will disseminate results through academic conferences and publications, and to other relevant stakeholders. Project Number: 1R01CA306909-01 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Coleman Drake (+1 co-PI) | Institution: UNIVERSITY OF PITTSBURGH AT PITTSBURGH, PITTSBURGH, PA | Award Amount: $649,620 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-P (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11267725