In the next few weeks — by December 7, 2022 — more than 64 million Americans will be choosing their Medicare coverage for next year. If you are eligible for Medicare, you can either sign up for traditional Medicare, or choose to have a Medicare Advantage plan. If you choose a Medicare Advantage plan, Medicare will pay a private sector health insurance company a fixed payment to cover your healthcare needs.
As its name suggests, an Advantage plan does offer added benefits, but when it comes to certain cancer treatments and treatment in large hospitals and medical centers connected to medical schools, a new study shows that traditional Medicare might be a better choice.
Medicare Advantage offers some persuasive perks. Depending on the insuring company, it may include fitness programs — including gym memberships or discounts; some vision, hearing and dental services like routine check-ups or cleanings. And some plans may have lower out-of-pocket costs for particular treatments.
One of the notable downsides to Advantage plans is that you have to stay “in-network” — only choosing from among the network’s own doctors and hospitals — and you may find you need referrals and approvals for treatment.
Traditional Medicare beneficiaries were more likely to be treated at hospitals with a higher median number of total beds, ICU beds, operating rooms and annual inpatient surgical volume.
Medicare Advantage plans fall short when it comes to early cancer treatment, the study found. “The study suggests that cancer patients with Medicare Advantage would experience better short-term health outcomes if more of them had access to hospitals that frequently perform complex cancer surgery,” the lead author of the study, Mustafa Raoof, a surgical oncologist at City of Hope, a cancer treatment center in California, said in a press statement. “Research has repeatedly linked improved surgical outcomes to cancer patients who received care at National Cancer-designated cancer centers, such as City of Hope, or at hospitals with high surgery volumes or that are accredited by the Commission on Cancer.”
Researchers analyzed California Cancer Registry data from over 76,000 Medicare beneficiaries who underwent elective inpatient cancer surgery of the lung, esophagus, stomach, pancreas, liver, colon or rectum. The City of Hope research team found that Medicare Advantage cancer patients who had their stomach or liver removed were 1.5 times more likely to die within the first month after surgery compared to their peers with traditional Medicare. What’s more, Medicare Advantage members who had cancer surgery of the pancreas were twice as likely to die within the first month.
On the other hand, people with traditional Medicare were more likely to be treated at:
- Teaching hospitals affiliated with a medical school (23 percent vs 8 percent)
- Hospitals accredited by the Commission on Cancer (57 percent vs. 33 percent)
- National Cancer Institute-designated cancer centers (15 percent vs. 3 percent)
Traditional Medicare beneficiaries were also more likely to be treated at hospitals with a higher median number of total beds, ICU beds, operating rooms and annual inpatient surgical volume.
One of the notable downsides to Medicare Advantage plans is that you can only choose from among the Advantage Plan’s doctors and hospitals, and you may need referrals and approvals for treatment elsewhere.
Before signing up for a Medicare Advantage plan, consider these questions suggested by the Medicare Rights Center, an independent source of Medicare information and assistance in the U.S.:
- Will I be able to use my doctors? Are they in the plan’s network?
- Do doctors and providers I want to see in the future take new patients who have this plan?
- If my providers are not in-network, will the plan still cover my visits?
- Which specialists, hospitals, home health agencies, and skilled nursing facilities are in the plan’s network?
- What is the service area for the plan?
- Am I covered for care received outside the service area?
- Who can I choose as my Primary Care Provider (PCP)?
- Does my doctor need to get approval from the plan to admit me to a hospital?
The study is published in the Journal of Clinical Oncology.