Medicare Advantage Is Linked to Higher Hospice Use in Advanced Cancer Patients

Medicare decedents, specifically those with advanced cancers on Medicare Advantage (MA), had higher hospice utilization than those under traditional Medicare or those who switched between plans.¹

These findings, published in JAMA Network Open, aimed to quantify the utilization implications of hospice end-of-life (EOL) care and to understand the financial incentives that might influence patients’ decisions about whether to stay on or switch plans.¹ Researchers observed that more patients who resided in areas with lower socioeconomic status and those in racial or ethnic minority groups were more likely to switch from MA to traditional Medicare (TM).¹ Despite financial assistance programs such as Medicare Part A and Part B, TM beneficiaries still struggle to afford their premiums and cost sharing, especially those with incomes between 100% and 150% of the federal poverty line.² This study does not address the financial burdens or incentives that may influence patients’ decisions to switch or continue on their plan through EOL care; however, the patient demographics of those who switch from MA to TM suggest that other socioeconomic factors may influence their decision.¹

This retrospective cohort study included 196,536 Medicare decedents newly diagnosed with female breast cancer (5.5%), colorectal cancer (14.8%), non–small cell lung cancer (48.6%), small cell lung cancer (10.9%), pancreatic cancer (11.0%), and prostate cancer (9.2%). A total of 46.5% were female, 53.5% were male, and 49.2% were aged 66 to 74 years. Plan switching was measured up to 1 year before death and classified into 5 patterns: continuous TM, continuous MA, switching from TM to MA, switching from MA to TM, and other switching patterns (ie, multiple switches).¹

The primary outcome was hospice enrollment in the last year of life. Total length of hospice stays and the site of hospice service were also assessed.

The researchers observed that plan switching was infrequent. Overall, 1.5% of decedents switched from TM to MA, and 1.8% switched from MA to TM. Those with specific patient demographics were more likely to switch from MA to TM vs those with continuous TM; they tended to be younger (66-74 years: 53.8% vs 49.0% with continuous TM), be from a racial or ethnic minority group (non-Hispanic Black: 16.2% vs 9.0%), or reside in areas with lower socioeconomic status (Yost quintile 1: 20.1% vs 16.2%).¹

Notably, a higher proportion of dually enrolled beneficiaries switched from TM to MA (18.3%) and vice versa (22.2%) than those with continuous TM (12.2%) or MA (12.5%).¹

Hospice Utilization

Beneficiaries with continuous MA had the highest hospice enrollment in their last year of life (74.8%), followed by those who switched from TM to MA (69.0%), those with continuous TM (68.5%), and those who switched from MA to TM (66.4%; P < .001). Multivariable logistic regression showed a persistent difference: Beneficiaries with continuous MA had a higher likelihood of hospice enrollment (6.93 percentage points [PP]; 95% CI, 6.50-7.37) than those with continuous TM coverage. Similarly, those who switched between plans (TM to MA [2.92 PP; 95% CI, 1.30-4.54] and MA to TM [2.77 PP; 95% CI, 1.32-4.22]) had a higher likelihood of enrolling in hospice than those with continuous TM coverage.¹

Regarding specific patient demographics, non-Hispanic Black (−8.56 PP; 95% CI, –9.30 to −7.82) and Hispanic beneficiaries (−2.62 PP; 95% CI, –3.42 to −1.83) had a lower likelihood of hospice enrollment compared with non-Hispanic White beneficiaries.¹

The total median hospice stay length was longer among beneficiaries with continuous MA (48.3 days) than among those with continuous TM (43.8 days), those who switched from TM to MA (42.7 days), and vice versa (42.1 days).¹

The most common place for hospice services was at home, reported by 70.4% of hospice enrollees, followed by hospice facilities (10.8%), nursing homes (9.6%), and inpatient facilities (7.6%). Patients who had continuous MA (1.93 PP; 95% CI, 1.40-2.45), were older (≥ 85 years vs 66-74 years: 2.43 PP; 95% CI, 1.70-3.16), female (1.88 PP; 95% CI, 1.37-2.39), and Hispanic (4.89 PP; 95% CI, 3.96-5.81) were more likely to receive at-home hospice care compared with non-Hispanic Black beneficiaries (−1.95 PP; 95% CI, –2.80 to −1.10) and those with newly gained dual coverage (−31.98 PP; 95% CI, –33.69 to –30.27).¹

This study was limited because a causal relationship between plan switching and hospice utilization or place of hospice care could not be inferred. Furthermore, outcome measures such as last hospice enrollment and length of hospice stay may not capture all dimensions of hospice quality.¹

“Future research to understand potential care coordination gaps, access to patient-centered hospice care settings, and barriers to plan switching for medically vulnerable beneficiaries is critical to identify targeted interventions to promote equitable and patient-centered EOL care,” the study authors concluded.¹

References

1. Hu X, Jiang C, Kwon Y, et al. Medicare plan switching and hospice care among decedents with advanced cancer. JAMA Netw Open. 2026;9(3):e260755. doi:10.1001/jamanetworkopen.2026.0755

2. McCormick B. Medicare beneficiaries with near low income face highest health care affordability challenges. AJMC. September 22, 2025. Accessed March 24, 2026. https://www.ajmc.com/view/medicare-beneficiaries-with-near-low-income-face-highest-health-care-affordability-challenges