It’s 2024 and your doctor says that you have cancer.
Will your health insurance give you access to the best possible treatment?
That’s a question over 60 million Medicare recipients should consider during the 2024 Medicare open enrollment period – starting on October 15th and running through December 7th – because age is a significant risk factor for getting cancer.
For people who develop complex cancers, the plan they choose could have a major impact on their eventual survival.
One option for Medicare recipients is Medicare Advantage, the health coverage offered by private insurers. It is usually less expensive than original Medicare, and offers extras such as vision, hearing, and dental coverage. It can be a great choice for many recipients, particularly for people with fixed budgets. About half of Medicare recipients choose it.
But Medicare Advantage plans come with a little-known catch: They frequently have narrow provider networks that do not include the research medical centers that provide access to clinical trials and the most advanced treatment, such as genomic-based precision medicine and CAR T immunotherapies.
In America today, if you have a cancer which requires a relatively straightforward or well-established standard treatment protocol, you can get very good treatment at most community hospitals and oncology practices.
But if you have a complex cancer – one that is rare or caused by a recently identified genetic profile, or requires the coordination of a number of modes of therapy – a narrow provider network may not offer you enough.
Cancer patients with traditional Medicare do have access to Comprehensive Cancer Centers that offer the latest in diagnostics and treatment. But 60 percent of Medicare Advantage plans do not include access to any of the 56 NCI-designated Comprehensive Cancer Centers. And even if one of these centers is technically in their network, many Medicare Advantage enrollees will experience barriers when trying to access these pre-eminent centers.
As a result, people with Medicare Advantage are only one fifth as likely to be treated for cancer at an NCI-designated center than people with traditional Medicare. And they are one third as likely to be treated at any academic medical center.
The implications of this disparity can be staggering.
For some complex procedures, Medicare Advantage cancer patients have higher mortality rates than patients with traditional Medicare.
For example, Medicare Advantage patients who have surgery for pancreatic cancer are twice as likely to die in the month after surgery than those with traditional Medicare.
Medicare Advantage patients with stomach and liver cancer are fifty percent more likely to die during the month after surgery.
But the differences in outcomes are not driven by surgical rates alone.
For example, if you are a Medicare Advantage patient and need CAR T cell therapy, you may not have access to it at the hospitals in your network. That can mean the difference between life and death, since CART T cell therapies have increased the success rates of treatment for certain leukemias and lymphomas by 50 to 80 percent.
The same is true of clinical trials. These trials often involve highly promising drugs that won’t be available to the general public for years. If you are in many Medicare Advantage plans, and don’t have access to an academic center, you are far less likely to be enrolled into a clinical trial.
My institution is working with others to advocate for policy changes to include Comprehensive Cancer Centers and other research centers in every Medicare Advantage provider network. But whether or not such reforms eventually take place, the time for seniors to make a very important healthcare choice is now.
If you are a senior with a history of cancer or risk factors that make getting it more likely, or you just want to cover all your bases, you should check to see what cancer centers are available in any plan you consider joining. If you don’t find a plan that includes a cancer center where you would be comfortable receiving care, you may want to consider traditional Medicare, with its access to cutting edge cancer centers.
There is no one right choice for everyone. But if seniors take the time to research the cancer care available under various types of Medicare coverage they can find something we all want: peace of mind.
BIO: Harlan Levine is President of Health Innovation and Policy at City of Hope, a National Comprehensive Cancer Care Center
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