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Association of Medicare eligibility with access to and affordability of care among older cancer survivors

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Abstract

Purpose

Older cancer survivors have substantial needs for ongoing care, but they may encounter difficulties accessing care due to cost concerns. We examined whether near-universal insurance coverage through Medicare—a key source of health insurance coverage in this population—is associated with improvements in care access and affordability among older cancer survivors around age 65.

Methods

In a nationally representative sample of cancer survivors (aged 50–80) from 2006–2018 National Health Interview Survey, we employed a quasi-experimental, regression discontinuity design to estimate changes in insurance coverage, delayed/skipped care due to cost, and worries about or problems paying medical bills at age 65.

Results

Medicare coverage sharply increased from 8.3% at age 64 to 98.2% at age 65, ensuring near-universal insurance coverage (99.5%). Medicare eligibility at age 65 was associated with reductions in delayed/skipped care due to cost (discontinuity, − 5.7 percentage points or pp; 95% CI, − 8.1, − 3.3; P < .001), worries about paying for medical bills (− 7.7 pp; 95% CI, − 12.0, − 3.2; P = .001), and problems paying medical bills (− 3.2 pp; 95% CI, − 6.1, − 0.2; P = .036). However, a sizable proportion reported any access or affordability problems (29.7%) between ages 66 and 80.

Conclusions

Near-universal Medicare coverage at age 65 was associated with a reduction—but not elimination—of access and affordability problems among cancer survivors.

Implications for Cancer Survivors

These findings reaffirm the role of Medicare in improving access and affordability for older cancer survivor and highlight opportunities for reforms to further alleviate financial burden of care in this population.

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Data availability

The data used for the analysis were publicly available; the cleaned data and the codes accompanying the analysis will be archived in a GitHub repository (https://github.com/yok84/NHIS-Cancer-Survivorship-and-Medicare-RD-Analysis.git) upon publication of the manuscript.

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Funding

This research was supported by grant number R36HS029262-01A1 from the Agency for Healthcare Research and Quality.

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Authors and Affiliations

  1. Department of Health Policy and Management, University of Pittsburgh, School of Public Health, A610 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA

    Youngmin Kwon, Howard B. Degenholtz & Lindsay M. Sabik

  2. Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, USA

    Eric T. Roberts

  3. Department of Urology, Division of Health Services Research, University of Pittsburgh, School of Medicine, 3471 Fifth Ave, Suite 801, Pittsburgh, PA, 15213, USA

    Bruce L. Jacobs

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Contributions

Y.K. developed the design of the study. Y.K., E.R., and L.S. contributed to the formal statistical analysis. Y.K., E.R., H.D., B.J., and L.S. were involved in interpretation of data and manuscript development. All authors read and approved the final manuscript.

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Correspondence to Youngmin Kwon.

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Kwon, Y., Roberts, E.T., Degenholtz, H.B. et al. Association of Medicare eligibility with access to and affordability of care among older cancer survivors. J Cancer Surviv (2024). https://doi.org/10.1007/s11764-024-01562-x

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