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Oncology Organization and Oncologist Networks Under Medicare Advantage Plans
Xin Hu1,2,3, Youngmin Kwon4, Qinjin Fan5
1Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, Georgia.
Importance:
More than half of Medicare beneficiaries are now enrolled in Medicare Advantage (MA) plans. These plans offer lower premiums and additional benefits compared with Traditional Medicare (TM) but commonly restrict organization and clinician networks, potentially limiting access to specialists, including oncologists. Little is known about the use of oncology networks in MA plans.
Objective:
To evaluate effective oncology network breadth under MA plans based on realized health care utilization.
Design, Setting, And Participants:
This cross-sectional study used linked 2016-2019 Surveillance, Epidemiology, and End Results (SEER)-Medicare data to characterize effective oncology networks among beneficiaries diagnosed with 8 common cancers. Network trends were examined separately for regular MA plans and special needs plans (SNPs) within SEER counties, and network breadth was compared by metropolitan status and plan type (health maintenance organization [HMO], local or regional preferred provider organization [PPO], point-of-service [POS] plan, or other). Data were analyzed between March 1, 2025, and April 1, 2026.
Main Outcomes And Measures:
Effective oncology network breadth was defined at the plan-county-year level as the share of oncology organizations and oncologists accessed by MA beneficiaries relative to oncology organizations and oncologists accessed by TM beneficiaries in the same county-year, measured separately for oncology organizations, medical or surgical oncologists, and radiation oncologists and more than 1 MA-recorded visit to a National Cancer Institute (NCI)-designated comprehensive cancer center.
Results:
A total of 807 580 MA beneficiaries (mean [SD] age, 70.4 [9.0] years; 420 662 males [52.1%]) were identified, representing 23 255 plan-year observations for regular MA plans and 17 716 for SNPs from 2016 through 2019. Across regular MA plans, beneficiaries accessed a mean (SD) of 12.0% (12.7%) of oncology organizations, 6.8% (9.6%) of medical or surgical oncologists, and 11.6% (13.8%) of radiation oncologists; across SNPs, beneficiaries accessed 12.4% (12.6%) of oncology organizations, 7.2% (8.6%) of medical or surgical oncologists, and 12.7% (15.5%) of radiation oncologists. MA-recorded visits to NCI-designated comprehensive cancer centers were observed in 25.7% (n = 5983 of 23255) of regular MA plans and 20.5% (n = 3624 of 17716) of SNPs. Effective oncology network breadth was narrower for HMOs; nonmetropolitan (vs metropolitan) counties and regional PPOs (vs other plan types) had lower likelihood of MA-recorded visits to NCI-designated comprehensive cancer centers.
Conclusions And Relevance:
In this cross-sectional study of MA plans in SEER regions from 2016 to 2019, effective oncology organization and oncologist networks were constrained. Restricted access to NCI-designated comprehensive cancer centers might limit access to innovative treatments and cancer outcomes, which warrants future research.
Insights
Medicare Advantage (MA) plans often have limited oncology networks, restricting access to specialists and cancer centers. This may impact cancer treatment and outcomes for beneficiaries.
Area of Science:
- Oncology
- Health Services Research
- Health Policy
Background:
- Over half of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans.
- MA plans offer benefits but may restrict provider networks, potentially limiting access to oncologists.
- Limited data exists on the scope of oncology networks within MA plans.
Purpose of the Study:
- To assess the breadth of oncology networks in Medicare Advantage plans.
- To evaluate healthcare utilization patterns within these networks.
Main Methods:
- Cross-sectional study using 2016-2019 SEER-Medicare data.
- Analyzed oncology network access for 8 common cancers among MA beneficiaries.
- Compared network breadth by plan type (HMO, PPO, etc.), metropolitan status, and Traditional Medicare (TM) access.
Main Results:
- MA beneficiaries accessed a small percentage of available oncology organizations and oncologists.
- Access to National Cancer Institute (NCI)-designated comprehensive cancer centers was limited in MA plans.
- Network breadth varied by plan type, with Health Maintenance Organizations (HMOs) showing narrower networks.
Conclusions:
- Effective oncology networks in MA plans are constrained.
- Limited access to NCI-designated centers may hinder access to novel treatments and affect cancer outcomes.
- Further research is needed to understand the implications for cancer care.
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