Cost-Sharing for Part B Chemotherapy Drugs in Medicare Advantage Plans: an Administrative Data Analysis
In 2017, a third of Medicare beneficiaries chose a Medicare Advantage (MA) managed care plan.1 These plans cover traditional Medicare services and optional extra benefits like dental care. Unlike traditional Medicare, these plans can restrict provider networks and require prior authorization. Cancer patients in MA plans have historically had slightly higher out-of-pocket costs (excluding premiums) than traditional Medicare beneficiaries with supplemental insurance.2
MA members’ out-of-pocket costs for cancer treatment may be affected by several recent federal regulations intended to prevent patients with expensive health needs from avoiding MA plans due to high cost-sharing requirements.3 Since 2011, almost all MA plans are required to offer out-of-pocket limits ($6700 maximum) that apply to cost-sharing for all services except Part D drugs.4
Cost-sharing for chemotherapy drugs administered in an outpatient setting or clinical office is also regulated. Since 2011, MA plans...
Dr. Keohane’s effort on this study was supported by a Career Development Award from the National Institute on Aging (K01AG058700).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.Jacobson G, Damico A, Neuman T, and Gold M. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Available at: https://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/. Accessed October 29, 2018.
- 3.Centers for Medicare and Medicaid Services. Medicare program; policy and technical changes to the Medicare Advantage and Medicare prescription drug benefit programs; final rule: 6. Maximum Allowable Cost Sharing Amount for Medicare Parts A and B Services and Prescription Drugs 2010. Available at: http://www.gpo.gov/fdsys/pkg/FR-2010-04-15/pdf/2010-7966.pdf. Accessed October 29, 2018.
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