MA Linked to Similar Cancer Treatment Use, Lower Anticipated Costs vs Traditional Medicare

Medicare Advantage (MA) insurance was associated with lower anticipated treatment costs than traditional Medicare (TM) among beneficiaries initiating pharmacologic cancer therapy, while both groups had similar use of optimal treatments and time to treatment initiation, according to a study published today in JAMA Internal Medicine.¹

Evaluating the Impact of MA vs TM on Cancer Treatment Selection and Spending

More than half of Medicare beneficiaries are now covered by private MA plans, with enrollment continuing to grow, creating a critical need to understand the financial costs and health outcomes for MA beneficiaries.²

Prior research has generally found lower per-enrollee spending among MA beneficiaries.¹ MA has also been associated with reductions in low-value cancer services, which can improve care quality.³ By contrast, MA beneficiaries are less likely to receive high-cost cancer drugs, some of which have been shown to improve patient outcomes.¹

Researchers highlighted that it remains unknown whether MA plans reduce access to these expensive but clinically necessary cancer treatments. Consequently, they conducted a study to determine whether there are differences in guideline-concordant care or treatment costs for beneficiaries insured under MA vs TM. Specifically, the investigators compared cancer treatment selection, timeliness, and anticipated cost by payer type.

Using Medicare data, they analyzed the pharmacologic cancer treatment initiated by each patient among available options. Treatments were linked by diagnosis date to contemporary National Comprehensive Cancer Network guideline recommendations and Medicare reimbursement rates to determine the coprimary outcomes: receipt of optimal treatment for each cancer type and anticipated treatment cost.

The researchers then assessed the association of outcomes with insurance type using generalized estimating equations to estimate risk ratios (RRs) after balancing patient characteristics through inverse probability-of-treatment weighting. They clustered models at the physician level and adjusted for scenario, diagnosis year, scenario x diagnosis year interaction, and oncologist characteristics.

Treatment Patterns Were Similar Between MA and TM, With Lower Adjusted Costs in MA

The study included 13 clinical scenarios, comprising 35,245 patients, of whom 68.9% (n = 24,269) were enrolled in TM and 31.1% (n = 10,976) in MA. The patients had a median (IQR) age of 74 (70-79) years, and most were male (63.2%). Compared with TM beneficiaries, MA enrollees were more likely to reside in ZIP codes with median income less than $50,000 (17.2% vs 13.0%) but less likely to receive low-income subsidies (16.7% vs 20.9%) or reside in rural areas (12.7% vs 23.3%).

Of the MA patients, 87.8% (n = 9634) initiated any systemic therapy vs 86.9% (n = 21,085) of TM patients. Meanwhile, 40.3% (n = 4425) of MA patients initiated the optimal therapy for their cancer type vs 39.1% (n = 9492) of TM patients. The median (IQR) time to treatment initiation was 36 (20-60) days for MA beneficiaries vs 35 (19-59) days for TM patients.

The unadjusted mean (SD) cost of the initiated treatment was $29,252 ($80,391) for MA patients vs $40,874 ($106,205) for TM patients. Meanwhile, the median (IQR) was $3143 ($2536-$18,317) for MA beneficiaries and $3143 ($2553-$20,128) for TM patients.

In unadjusted analyses, MA was associated with a treatment cost ratio of 0.78 (95% CI, 0.74-0.83) of the TM cost. After adjusting for year, scenario, oncologist characteristics, and treatment rank order, the MA cost ratio was 0.94 (95% CI, 0.91-0.97) of the TM cost. The researchers noted that the approximately 6% reduction would translate into a mean reduction of −$931 (95% CI, −$1244 to −$615).

Future Research Should Examine Outcomes Across the Cancer Care Continuum

The researchers acknowledged their study’s limitations, including the potential underascertainment of patients who did not receive treatment due to their reliance on claims data. Additionally, the findings may not be generalizable to plans with incomplete reporting or to cancer types not included in the analyzed scenarios. They concluded by identifying areas for further research.

“Further research is needed to assess differences later in the cancer care continuum, such as adherence, subsequent-line therapy, and end-of-life care,” the authors wrote.

References

1. Mitchell AP, Dusetzina SB, Mishra Meza A, et al. Quality, cost, and timeliness of cancer treatment in Medicare Advantage and traditional Medicare. JAMA Intern Med. Published online July 13, 2026. doi:10.1001/jamainternmed.2026.2864
2. Cubanski J, Freed M, Ochieng N, Cottrill A, Biniek J, Neuman T. Medicare 101. KFF. October 8, 2025. Accessed July 13, 2026. https://www.kff.org/medicare/health-policy-101-medicare/
3. Jung J, Carlin C, Feldman R, Song G, Mitchell A. Use of low-value cancer treatments in Medicare Advantage versus traditional Medicare. J Clin Oncol. 2025;43(20):2245-2254. doi:10.1200/JCO-24-01907