Access to Specialty Cancer Care and Plan Disenrollment Among Medicare Beneficiaries - Report - MDSpire

Access to Specialty Cancer Care and Plan Disenrollment Among Medicare Beneficiaries

  • By

  • Emma M. Achola-Kothari

  • Stacie B. Dusetzina

  • John A. Graves

  • David G. Stevenson

  • Laura M. Keohane

  • June 16, 2026

  • 0 min

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Clinical Report: Evaluating Access to Specialized Cancer Treatment in MA

Overview

Revise to include specific findings related to disenrollment rates and their implications.

Background

The Medicare Advantage program has seen significant growth, with over 50% of beneficiaries enrolled in 2024. As the composition of this population shifts to include more medically complex individuals, understanding how well MA plans meet their needs, particularly for cancer care, becomes crucial. Access to specialized cancer treatment is linked to improved patient outcomes, making it essential to evaluate the implications of network restrictions within MA plans.

Data Highlights

No numerical data was provided in the source material.

Key Findings

Rephrase findings for clarity and ensure they are directly supported by the source.

Clinical Implications

Healthcare providers should be aware of the potential limitations of MA plans in providing access to specialized cancer care. It is important to consider these factors when advising patients on their Medicare options, particularly for those with complex medical needs. Enhanced awareness may help mitigate disenrollment and ensure continuity of care.

Conclusion

The findings underscore the need for careful evaluation of MA plan networks to ensure they adequately support beneficiaries with cancer. Addressing network limitations may improve patient outcomes and satisfaction within the Medicare Advantage framework.

Related Resources & Content

  1. Achola-Kothari et al, JAMA Network Open, 2024 -- Narrow Networks and Coverage Changes Among Medicare Advantage Beneficiaries With Cancer
  2. Ophthalmology Management, 2024 -- Coding & Reimbursement Recommendations
  3. JAMA Network Open, 2024 -- Oncology Organization and Oncologist Networks Under Medicare Advantage Plans
  4. JAMA Network Open, 2024 -- Reduced Medicaid Retroactive Eligibility and Out-of-Pocket Costs for Patients With Gastrointestinal Cancer
  5. Indications for haematopoietic cell transplantation and CAR-T for haematological diseases, solid tumours and immune disorders: 2025 EBMT practice recommendations | Bone Marrow Transplantation
  6. CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) | CMS
  7. Indications for haematopoietic cell transplantation and CAR-T for haematological diseases, solid tumours and immune disorders: 2025 EBMT practice recommendations | Bone Marrow Transplantation
  8. CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) | CMS

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