Jazowski Shelley A, Achola Emma M, Nicholas Lauren Hersch, Kwon Youngmin, Wood William A, Friese Christopher R, Dusetzina Stacie B
Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA Netw Open. 2025 Jun 2;8(6):e2513394. doi: 10.1001/jamanetworkopen.2025.13394.
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.
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.
Self-reported initial Medicare plan selection (traditional Medicare [TM] without supplemental coverage, TM plus supplemental coverage, or Medicare Advantage [MA]) and history of cancer.
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.
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.
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.
在患有癌症的医疗保险受益人中，补充保险（如医疗补助保险）在医疗保险参保和退保方面的作用尚未得到充分研究。了解最初选择补充保险与更换保险计划之间的关联，对于确保为患有高成本健康状况的受益人提供充足且负担得起的保险至关重要。
根据最初的保险计划选择和癌症病史评估医疗保险计划的更换情况。
设计、背景和参与者：这项队列研究使用了2008年至2020年健康与退休研究的数据。受访者在最初选择医疗保险计划时年龄为65岁或66岁，并连续完成了两次调查。分析于2023年11月至2024年10月进行。
自我报告的最初医疗保险计划选择（无补充保险的传统医疗保险[TM]、TM加补充保险或医疗保险优势计划[MA]）和癌症病史。
主要结局是自我报告的在最初选择计划后2年内的医疗保险计划更换情况。采用修正泊松回归来评估最初医疗保险计划选择与计划更换之间的关联。模型对基线社会人口统计学和健康相关特征进行了调整，并按癌症病史进行了分层。
在2852名进入医疗保险的受访者中（1113名男性[39.02%]），1511名（52.98%）最初选择了TM加补充保险，358名（12.55%）报告有癌症病史。不到三分之一的受益人（786名无癌症病史的受益人[31.52%]和106名有癌症病史的受益人[29.61%]）在最初选择计划后的2年内更换了保险。大多数受益人从无补充保险的TM转向了具有更大财务保护的保险；227名无癌症病史的受益人中有131名（57.71%）转向了MA，27名有癌症病史的受益人中有18名（66.67%）转向了TM加补充保险。在无癌症病史的受益人中，最初选择MA（调整风险比[aRR]，0.55；95%置信区间[CL]，0.47 - 0.64）或TM加补充保险（aRR，0.63；95% CL，0.55 - 0.72）与更换保险的可能性较低相关。有癌症病史的受益人的结果类似。
在这项针对有和没有癌症病史的老年人的队列研究中，最初选择MA或TM加补充保险与更换保险的可能性较低相关。鉴于具有更大财务保护的保险可能满足受益人的不断变化的需求和偏好，政策制定者应考虑提高TM的充足性。
