Cancer Care Unaffordable for Medicare Beneficiaries

Findings from a new study suggest that Medicare beneficiaries may face financial hardships due to the high cost of most cancer treatments, and increased cost sharing.

Although many cancer-related deaths are seen in beneficiaries, traditional Medicare requires that these patients pay high out-of-pocket costs without a maximum. Beneficiaries who are enrolled in a health maintenance organization (HMO) face similar challenges.

While supplemental insurance is available, the design of traditional Medicare can leave elderly adults with significant medical costs that they may not be able to afford, which can lead to treatment nonadherence and poor health outcomes, according to a study published by JAMA Oncology.

The study included data from 18,166 Medicare beneficiaries, with 1409 receiving a diagnosis of cancer from 2002 to 2012. Surveys identified patients with a cancer diagnosis, or those who were diagnosed with heart disease, lung disease, stroke, dementia, and/or type 1 or type 2 diabetes.

Patients were queried about their out-of-pocket healthcare spending for the past 2 years, and prescription drugs for the previous month. Patients were also asked about their total household income to better determine the impact of out-of-pocket spending on cancer treatments.

The researchers found that patients who were newly diagnosed with cancer were more likely to be male, white, non-Hispanic, and self-report good to excellent health status, despite heart or lung disease.

Interestingly, patients who were diagnosed with cancer generally had higher incomes, compared with those who did not develop cancer (third and fourth quartiles, 57.0% vs 48.8%), according to the study. Those who were diagnosed with cancer and had lower incomes were more likely to also be insured through Medicaid or lack supplemental insurance.

The researchers found that mean out-of-pocket spending was $3737 per patient, a financial burden of $11.4%, with some spending as much as $8078 (29.6% of income) annually. Diagnosis of cancer or a chronic condition was linked to an increased risk of out-of-pocket costs, compared with all patients.

The investigators found that patients without supplemental insurance who were diagnosed with cancer had higher mean out-of-pocket costs, compared with those diagnosed with other chronic diseases.

Patients without supplemental insurance experienced the highest out-of-pocket costs among all patients, despite having less income than other patients, excluding those covered by Medicaid, according to the study. These patients spend a mean of 23.7% of their annual income on out-of-pocket costs, with some patients spending up to 63.1% of their incomes.

Among the patients, the authors discovered that spending on inpatient hospitalization outweighed all other out-of-pocket spending, accounting for 42% of out-of-pocket spending for patients with cancer.

The authors found that 10% of patients spent more than 60% of their annual income in out-of-pocket costs related to a cancer diagnosis. They also found that inpatient spending was a main driver of Medicare spending, with many patients spending nearly half their annual income on these hospital stays.

These findings suggest that older adults with cancer have significant financial burden, which could result in Medicare beneficiaries not receiving proper care. The investigators suggest that implementing an urgent care clinic specifically for oncology patients may reduce hospitalizations and costs experienced by these patients.

Reforming Medicare to restructure hospital benefits and implementing an out-of-pocket maximum can reduce the financial burden faced by elderly adults with cancer, which could lead to better patient outcomes, the study concluded.