Out-of-Pocket Spending and Financial Burden Among Medicare Beneficiaries With Cancer

Abstract

Importance Medicare beneficiaries with cancer are at risk for financial hardship given increasingly expensive cancer care and significant beneficiary cost-sharing. Objective To measure out-of-pocket (OOP) costs incurred by Medicare beneficiaries with cancer and to identify which factors and services contribute to high OOP costs. Design Prospectively collected survey data from the 2002-12 waves of the Health and Retirement Study (HRS). Setting A nationally representative panel study of U.S. residents over age 50. Participants We studied 18,166 community-dwelling Medicare beneficiaries who participated in HRS, including 1,409 participants who were diagnosed with cancer over the study period. Main Outcome and Measures OOP medical spending and financial burden (OOP expenditures/household income). Results Type of supplementary insurance was significantly associated with mean annual OOP costs incurred following a cancer diagnosis (Medicaid: $2,116; VA: $2,367; Medicare HMO: $5,976; employer-sponsored: $5,492; Medigap: $5,670; none: $8,115). Beneficiaries with a new cancer diagnosis and Medicare alone incurred OOP expenditures that on average were 24% of their household income; 10% of these beneficiaries incurred OOP expenditures that were at least 63% of their household income. Among the 10% of beneficiaries with cancer who incurred the highest OOP costs, hospitalization contributed to 42% of total OOP costs. Conclusions and Relevance Medicare beneficiaries without supplemental insurance incur significant OOP costs following a diagnosis of cancer. Costs related to hospitalization may be a primary contributor to high OOP costs. Medicare reform proposals that restructure the benefit design for hospital-based services and that incorporate an OOP maximum may help alleviate financial burden, as can interventions that reduce hospitalization in this population.

Challenges around Access to and Cost of Life-Saving Medications after Allogeneic Hematopoietic Cell Transplantation for Medicare Patients

“…19 Lack of supplemental insurance can worsen the financial burden. 20 This poses a great challenge for most of these patients who have modest fixed incomes.…”

Ask Early and Ask Often

“…Medicare beneficiaries without supplemental insurance face high OOP costs for oral chemotherapy [9]. Most patients pay thousands of dollars in the first few months of therapy, and then meet the threshold for catastrophic coverage.…”

“…Patients without supplemental insurance on average spent nearly 1.5 times more, at $8,115 per year. This was equivalent to 23.7% of their household income [9]. Patients with a new diagnosis of cancer had 1.86 increased odds of having OOP expenditures in the highest decile, compared to patients without a new diagnosis of cancer [9].…”

“…This was equivalent to 23.7% of their household income [9]. Patients with a new diagnosis of cancer had 1.86 increased odds of having OOP expenditures in the highest decile, compared to patients without a new diagnosis of cancer [9]. Roughly 30% of cancer survivors nationwide report financial problems associated with their care, at least in part due to these high OOP expenditures [10].…”

Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer

“…[10–15] Antihypertensive, lipid-lowering and antidepressant medications are among the most commonly used prescription medications in this vulnerable population and adherence to these treatments is suboptimal. [16–18] Improving access to clinically effective medications for dual enrollees with cancer is critical given that dual enrollment and comorbid hypertension, diabetes and depression are independently associated with delayed cancer diagnosis, lower quality cancer treatment and adherence, and post-operative complications.…”