Medicare recipients are at their most medically vulnerable. To win, 1.9 million Americans with cancer need the correct therapy.
Over 70% of cancer-related fatalities occur in persons 65 and older. As they follow a loved one through the unwelcome, unexpected path of cancer treatment, many seniors are unaware that a Medicare Advantage (MA) plan can limit their access to care.
MA Patients Receive Less Cancer Care
Over half of Medicare enrollees are in Medicare Advantage (MA) plans. Medicare Advantage (MA) members can only use their plan’s network and, in some situations, their sub-contracted medical group, while those on normal Medicare can go to any Medicare-accepting doctor or hospital.
Academic medical centers (AMCs) and NCI-designated comprehensive cancer centers (NCI-CCCs) offer cell-based and immuno-oncology treatments first.
MA members are substantially less likely to obtain cancer treatment at a teaching hospital (23% with Medicare vs. 8% with MA), a Commission on Cancer-accredited institution (57% vs 33%), or an NCI-CCC-affiliated facility (15% vs 3%) than Medicare beneficiaries without MA.
Health plans and other risk-bearing entities should be required to show that they have processes and networks in place to guarantee that a cancer patient in need will not be denied timely and adequate care under the new value-based care paradigm.
Read more: Medicaid cuts in South Dakota: 22,000 at risk of losing coverage, with hope for some to regain it
Problems with Medicare Advantage Programs
Medicare Advantage Plans, in general, do not provide as many options as Original Medicare plus a Medigap policy.
The vast majority of policies stipulate that you see a doctor or hospital inside their network.
Since Medicare Advantage Plans are required to take on any Medicare-eligible participant regardless of health status, they discourage those who are already ill by imposing high out-of-pocket costs.
There have been widespread reports of enrollees being faced with unforeseen fees and having their benefits denied for treatment that was ultimately found unnecessary.
Read more: Consumption of alcoholic beverages is associated with an increase in chronic pain