MA Associated With Less Expensive Cancer Therapies but Similar Treatment Utilization Compared to TM
Key Takeaways:
- Beneficiaries enrolled in either traditional Medicare (TM) or Medicare Advantage (MA) had similar rates of initiating optimal treatment for cancer type, 39.1% and 40.3%, respectively.
- TM and MA beneficiaries had similar durations between cancer diagnosis and treatment initiation, indicating insurance time may not delay care.
- MA was associated with lower-cost treatments compared to TM, resulting in a 6% cost reduction.
With MA enrollment growing among Medicare beneficiaries, evaluating the mechanisms of cost reductions could provide a better understanding of how MA impacts health outcomes.
MA is associated with lower cancer care costs and reduced use of low-value services, mainly through utilization management policies such as prior authorization, network management, and step therapy. However, these policies may also incentivize reductions in medically necessary services, which could worsen health outcomes.
Study Methods and Outcomes
Researchers used Medicare claims and encounter data from 2015-2019 to compare treatment utilization and costs between TM and MA beneficiaries.
Outcomes included whether patients received optimal cancer treatment (according to National Comprehensive Cancer Network Guidelines) as well as anticipated treatment cost (according to Medicare reimbursement rates).
Patient Characteristics
The study included 35 245 patients, of whom 24 269 had TM and 10 976 had MA.
Compared to TM, patients enrolled in MA were more likely to be Black (12.2% vs 21.0%) and live in zip codes with a median income of less than $50 000 (13.0% vs 17.2%).
TM beneficiaries were more likely to receive low-income subsidiaries compared to MA beneficiaries, 20.9% vs 16.7%, respectively. TM also had more patients living in rural areas compared to MA, 23.3% vs 12.7%, respectively.
Treatment Patterns Among TM and MA Beneficiaries
Both MA and TM beneficiaries were likely to receive any systemic therapy, 87.8% and 86.9%, respectively. Both cohorts had similar rates of initiating optimal therapy for cancer type, 40.3% and 39.1%, respectively.
The median time between diagnosis and treatment initiation was 36 days for MA beneficiaries and 35 days for TM beneficiaries.
MA was associated with lower average treatment costs than TM, $29 252 vs $40 874, respectively. Overall, MA was associated with a 6% reduction in cancer treatment costs, translating to $931 in savings per patient.
Implications for Managed Care
These findings indicate that MA beneficiaries are just as likely as TM beneficiaries to initiate optimal therapies based on cancer type. MA was also associated with lower treatment costs compared to TM.
The authors noted that future research should assess differences in treatment adherence, subsequent therapies, and end-of-life care according to insurance type.
Reference
Mitchell AP, Dusetzina SB, Mishra Meza A, et al. Quality, cost, and timeliness of cancer treatment in Medicare Advantage vs. traditional Medicare. JAMA Intern Med. 2026;186(9):1135-1143. doi:10.1001/jamainternmed.2026.2864
