Medicare Plan Switching Among Beneficiaries With and Without a History of Cancer.

IMPORTANCE

The role of supplemental coverage (eg, Medigap) in Medicare enrollment and disenrollment is understudied among beneficiaries with cancer. Understanding the association between initially selecting a supplement and switching plans is necessary to ensure adequate and affordable coverage for beneficiaries with high-cost health conditions.

OBJECTIVE

To evaluate Medicare plan switching by initial plan selection and history of cancer.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Health and Retirement Study, from 2008 to 2020. Respondents were aged 65 or 66 years at initial Medicare plan selection and completed 2 consecutive surveys. Analyses were conducted from November 2023 to October 2024.

EXPOSURES

Self-reported initial Medicare plan selection (traditional Medicare [TM] without supplemental coverage, TM plus supplemental coverage, or Medicare Advantage [MA]) and history of cancer.

MAIN OUTCOMES AND MEASURES

The primary outcome was self-reported Medicare plan switching in the 2 years after initial plan selection. Modified Poisson regression was used to assess the association between initial Medicare plan selection and plan switching. Models adjusted for baseline sociodemographic and health-related characteristics and were stratified by a history of cancer.

RESULTS

Among 2852 respondents aging into Medicare (1113 male [39.02%]), 1511 (52.98%) initially selected TM plus supplemental coverage and 358 (12.55%) reported a history of cancer. Less than one-third of beneficiaries (786 beneficiaries without a history of cancer [31.52%] and 106 beneficiaries with a history of cancer [29.61%]) switched coverage in the 2 years after initial plan selection. Most beneficiaries switched from TM without supplemental coverage to benefits with greater financial protections; 131 of 227 beneficiaries without a history of cancer (57.71%) switched to MA, and 18 of 27 beneficiaries with a history of cancer (66.67%) switched to TM plus supplemental coverage. Among beneficiaries without a history of cancer, initial selection of MA (adjusted risk ratio [aRR], 0.55; 95% confidence limit [CL], 0.47-0.64) or TM plus supplemental coverage (aRR, 0.63; 95% CL, 0.55-0.72) was associated with a lower probability of switching coverage compared with initial selection of TM without supplemental coverage. Findings were similar for beneficiaries with a history of cancer.

CONCLUSIONS AND RELEVANCE

In this cohort study of older adults with and without a history of cancer, initial selection of MA or TM plus supplemental coverage was associated with a low likelihood of switching coverage. Given that benefits with greater financial protections may meet beneficiaries' evolving needs and preferences, policymakers should consider improving the adequacy of TM.