Access to care for older cancer survivors: Impacts of Medicare and supplemental insurance coverage

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PROJECT SUMMARY/ABSTRACT There is a growing population of older adult cancer survivors who have ongoing health care needs that stem from the lasting effects of cancer, cancer treatment, and other comorbidities. Fully 64% of cancer survivors in the US are ages 65 and older, making Medicare the largest payer for cancer survivorship care. Despite the ubiquity of Medicare coverage among cancer survivors, the effects of Medicare on access to care are yet to be extensively studied. There is also little evidence about how access to and affordability of care varies among Medicare beneficiaries who are cancer survivors. Medicare’s high cost-sharing may present barriers to care among cancer survivors, yet the extent to which individuals face these costs varies based on supplemental insurance. Therefore, the goal of this proposal is to analyze how the availability and levels of Medicare coverage (based on supplemental insurance) impact cancer survivors’ access to care. The proposed study will fill these evidence gaps using rich national survey data to evaluate the effects of Medicare coverage and the effects of supplemental insurance within Medicare on older adult cancer survivors’ access to care. Aim 1 will use the National Health Interview Survey (NHIS) to investigate how eligibility for Medicare affects self-reported cost barriers to access, exploiting abrupt coverage changes that occur at age 65 in a regression discontinuity design. Aim 2 will broadly examine how access to care differs by levels of supplemental coverage within Medicare, using patient-reported measures of health care access and affordability linked to detailed data on supplemental insurance coverage in the Medicare Current Beneficiary Survey (MCBS). Aim 3 will use the MCBS to evaluate the effects of Medicaid supplemental coverage, which covers Medicare beneficiaries of low socioeconomic status—including a disproportionate share of racial and ethnic minorities—on access to care. Aim 3 specifically explores these effects of Medicaid supplemental coverage (via the Qualified Medicare Beneficiary program) by exploiting an abrupt difference in Medicaid eligibility at 100% of the Federal Poverty Line using a regression discontinuity design. Together, these aims will provide novel evidence about the effects of Medicare coverage and variations in supplemental insurance within Medicare on older cancer survivors’ access to care. Findings from the proposed research will inform proposals under consideration to make Medicare accessible (e.g., lowering the eligibility age) and affordable (e.g. limiting or eliminating cost-sharing or expanding Medicaid supplemental coverage), meaningfully advancing AHRQ’s goal to produce evidence to make health care accessible, affordable, and equitable. This work is also inclusive of multiple AHRQ priority populations, including the elderly, low-income, racial/ethnic minorities, and those with severe comorbidities.