Narrow Networks and Coverage Changes Among Medicare Advantage Beneficiaries With Cancer
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By
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Xin Hu
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Haofan Yang
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John K. Lin
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June 16, 2026
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Clinical Scorecard: Medicare Advantage Beneficiaries with Cancer: Impact of Narrow Networks and Coverage Modifications
At a Glance
| Category | Detail |
|---|
| Condition | |
| Key Mechanisms | Narrow networks, prior authorization, formulary restrictions |
| Target Population | |
| Care Setting | |
Key Highlights
- 25% of beneficiaries with non-employer-sponsored MA plans switched after cancer diagnosis.
- Nearly half of MA beneficiaries enrolled in plans with fewer than 25% of local cancer hospitals.
- Higher switching rates observed among Black beneficiaries and those dually eligible for Medicare and Medicaid.
- MA enrollees had lower healthcare costs but higher 30-day mortality after complex cancer surgeries compared to TM enrollees.
Guideline-Based Recommendations
Diagnosis
Management
Monitoring & Follow-up
Risks
- Narrow networks may lead to inferior quality of care for patients with cancer.
- High switching rates may disrupt care continuity or postpone treatment initiation.
Patient & Prescribing Data
Medicare Advantage beneficiaries, particularly those newly diagnosed with cancer
Switching to other MA plans is common among those dissatisfied with narrow networks.
Clinical Best Practices
Related Resources & Content
