Medigap Protection and Plan Switching Among Medicare Advantage Enrollees With Cancer

Strategic Insights -

According to a recent study published in the Journal of the American Medical Association (JAMA) Health Forum, Medicare beneficiaries with cancer face significant challenges in accessing cancer care due to the features of Medicare Advantage (MA) plans. These plans impose utilization management restrictions, which may limit beneficiaries' ability to switch to traditional Medicare (TM) for better care. The study found that beneficiaries in states with guaranteed-issue Medigap protections were more likely to switch to TM after a new cancer diagnosis.

Key Takeaways:

  • The study analyzed data from 180,057 MA beneficiaries 69 years and older who were newly diagnosed with cancer from 2014 to 2019 in the Surveillance, Epidemiology, and End Results Program-linked Medicare database.
  • Beneficiaries in states with guaranteed-issue Medigap protections were more likely to switch to TM after a new cancer diagnosis, with a 2.5 percentage point increase in switching rates compared to other states.
  • The study found that the rate of switching in guaranteed-issue states increased from 2.1% to 4.7% following diagnosis, while the rate remained unchanged in other states (1.8% to 1.7%).
  • The study's findings underscore the protective association of state Medigap regulations in facilitating a switch to TM and highlight potential disparities in switching that may reflect unequal abilities to compare and afford plans.
  • The study identified key stakeholders involved in the research, including the Agency for Healthcare Research & Quality, Arnold Ventures, NIH National Institute on Aging (NIA), Leukemia and Lymphoma Society, NIH National Cancer Institute (NCI), California Department of Public Health, Centers for Disease Control & Prevention - USA, and NIH National Cancer Institute (NCI).

Statistics:

  • 180,057 MA beneficiaries 69 years and older were included in the analysis.
  • 44.5% of beneficiaries were diagnosed at age 69-75 years.
  • 51.5% of beneficiaries were male.
  • 8.0% of beneficiaries were Hispanic.
  • 7.4% of beneficiaries were non-Hispanic Black.
  • 78.5% of beneficiaries were non-Hispanic White.
  • 6.1% of beneficiaries were another or unknown race and ethnicity.
  • The rate of switching in guaranteed-issue states increased by 2.5 percentage points (95% CI, 1.9-3.2 percentage points).
  • The rate of switching in non-guaranteed-issue states remained unchanged (1.8% to 1.7%).

Sources:

  • Medigap Protection and Plan Switching Among Medicare Advantage Enrollees With Cancer. Jama Health Forum, 2025;6(6).
  • Vanderbilt University Medical Center, Dept. of Health Policy, 2525 West End Ave, Ste 1200, Nashville, TN 37203, United States.
  • Youngmin Kwon, Vanderbilt University Medical Center, Dept. of Health Policy, 2525 West End Ave, Ste 1200, Nashville, TN 37203, United States.
  • Emma M. Achola, John A. Graves, Laura M. Keohane, Stacie B. Dusetzina, Shelley A. Jazowski, and Xin Hu, Vanderbilt University Medical Center.