The Relationship between Health Insurance and Mortality for Cancer Patients: Medicare Advantage versus Fee-For-Service Medicare

Abstract

Compared to traditional fee-for-service Medicare (FFS), private Medicare Advantage (MA) plans offer additional health insurance coverage but restrict access to medical providers. This study measured how MA enrollment, relative to FFS enrollment, may influence mortality for cancer patients. The study used linked data from the Surveillance, Epidemiology, and End Results Program and Medicare administration (SEER-Medicare) including diagnoses between 2006 and 2011 at all four major cancer sites (breast, colorectal, lung, prostate). The key innovation of the study was to measure and account for variation in prescription drug coverage between MA and FFS cancer patients. Among cancer patients with Part D coverage, MA enrollment was associated with modestly increased mortality. The estimated relationships were statistically distinguishable from zero for lung cancer and (in most model specifications) colorectal cancer. The findings are consistent with a hypothesis that restricted provider access may reduce health outcomes for patients who already have a serious illness.