Medicare Plan Switching and Hospice Care Among Decedents With Advanced Cancer

Area of Science:

• Oncology
• Health Services Research
• Gerontology

Background:

• Hospice care is crucial for end-of-life (EOL) cancer patient management.
• Medicare Advantage (MA) excludes hospice benefits, covered by traditional Medicare (TM).
• Medicare plan switching patterns and their impact on EOL care are understudied.

Purpose of the Study:

• To investigate hospice utilization and care locations based on Medicare plan switching.
• To analyze how continuous MA, continuous TM, and plan switching affect EOL care.

Main Methods:

• Retrospective cohort study using SEER-Medicare data (2010-2019).
• Included patients aged ≥66 with advanced cancers (breast, colorectal, lung, pancreatic, prostate).
• Analyzed hospice enrollment, length of stay, and place of care using multivariable regressions.

Main Results:

• Continuous MA enrollees had the highest hospice enrollment (74.8%) and longest stays (48.3 days).
• Continuous MA beneficiaries were more likely to receive hospice at home.
• Switching from MA to TM increased nursing home hospice use, especially for dual-eligible enrollees.

Conclusions:

• Continuous MA enrollment is linked to higher rates of home hospice care.
• MA to TM switching may indicate access issues, leading to more nursing home hospice use.
• Addressing care coordination is vital to improve EOL care for cancer patients navigating Medicare plans.