New Study Finds Medicare Plan Type Shapes Hospice Use and End-of-Life Care for Cancer Patients

A recent study from researchers at Rollins School of Public Health found that patients with advanced cancer who were enrolled in different Medicare plan types and switched between plans showed different patterns of hospice care utilization in their final year of life. 

The research, published in JAMA Network Open, was led by Xin Hu, PhD, adjunct assistant professor in the Department of Health Policy and Management at Rollins.

Medicare Advantage (MA) and Traditional Medicare (TM) are two major types of Medicare programs. MA is the privately administered option, typically with lower premiums and supplemental benefits, but also with more restrictive provider networks and utilization management features. More than half of all Medicare beneficiaries—about 31.4 million people—are enrolled in MA, yet those plans do not directly cover hospice care. A “carve-in” for hospice care is currently being debated in Congress.

Hu’s team hypothesized that programmatic differences in MA plan benefit design could influence health care utilization patterns among patients with late-stage cancer. Using Medicare data on nearly 197,000 beneficiaries who died between 2010 and 2020 after an advanced diagnosis of female breast, colorectal, lung, pancreatic, or prostate cancers, they found that patients continuously enrolled in MA were more likely to use hospice, stay in hospice longer, and receive their last hospice service at home compared with patients enrolled in traditional Medicare. Since hospice is a "carve-out" benefit under MA plans, there is potentially a financial incentive to transition patients toward hospice early at end-of-life.

The researchers also found that those who switched from MA to TM were more likely to use hospice at a nursing home—particularly those dually covered by Medicaid—possibly due to underlying needs or preferences. This suggests that patients who switch may represent a group with higher nursing home care needs, but that face access barriers under MA plans at the end of their lives.

"Plan switching may signal unmet needs for patients and is particularly consequential for patients with advanced cancer near the end of life,” says Hu. “We need more research to understand the underlying reasons for these plan switching behaviors—such as potential provider network restrictions and prior authorization requirements—to inform ongoing MA plan monitoring and reform, as well as to ensure coordinated and patient-centered end-of-life care for patients with advanced cancer.”