Access to Specialty Cancer Care and Plan Disenrollment Among Medicare Beneficiaries
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By
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Emma M. Achola-Kothari
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Stacie B. Dusetzina
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John A. Graves
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David G. Stevenson
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Laura M. Keohane
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June 16, 2026
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Clinical Scorecard: Evaluating Access to Specialized Cancer Treatment and Medicare Beneficiary Plan Disenrollment
At a Glance
| Category | Detail |
|---|
| Condition | Medicare Advantage enrollment and access to cancer care |
| Key Mechanisms | Capitated payments, utilization management, network restrictions |
| Target Population | Medicare beneficiaries, particularly those newly diagnosed with cancer |
| Care Setting | Medicare Advantage plans |
Key Highlights
- Over 50% of Medicare beneficiaries enrolled in MA in 2024.
- Network restrictions in MA may limit access to specialized cancer care.
- Higher disenrollment rates observed among MA beneficiaries with new cancer diagnoses.
- Studies indicate that MA enrollees are less likely to receive care at top-ranked cancer centers.
- MA plans offer additional benefits like meal delivery and transportation.
Guideline-Based Recommendations
Diagnosis
- Utilize SEER-Medicare linked data for tracking new cancer diagnoses.
Management
- Consider the implications of network restrictions on access to specialized cancer care.
Monitoring & Follow-up
- Assess disenrollment rates among beneficiaries with complex medical needs.
Risks
- Exclusion of high-cost cancer centers from MA networks may negatively impact patient outcomes.
Patient & Prescribing Data
Medicare beneficiaries newly diagnosed with common cancers (lung, breast, leukemia, lymphoma, prostate, colorectal).
Beneficiaries may face challenges accessing specialized cancer treatment due to network limitations.
Clinical Best Practices
- Ensure access to CoC-accredited and NCI-designated cancer centers for optimal patient outcomes.
- Monitor the impact of MA plan structures on patient care and satisfaction.
Related Resources & Content
