State Medigap Policies and Disenrollment From Medicare Advantage Among Beneficiaries With Cancer.

Abstract

Medicare Advantage (MA) beneficiaries newly diagnosed with cancer may want to switch from MA into traditional Medicare and purchase supplemental insurance (Medigap), which provides important financial protections. However, beneficiaries in states without Medigap consumer protections may be denied or effectively denied (through high premiums) Medigap, potentially trapping them in MA. This study examined whether MA beneficiaries with newly diagnosed cancer were more likely to switch into traditional Medicare in states with stronger Medigap consumer protections. This retrospective study analyzed Medicare encounter data for beneficiaries age 65 years and older, continuously enrolled in MA from 2018 to 2019, and received a new cancer diagnosis in 2019. The primary exposure was state-level Medigap protections: no protections, community rating only (some protections), or both community rating and guaranteed issue (strongest protections). The outcome of interest was beneficiary-level disenrollment from MA into traditional Medicare in 2020. Among 426,248 MA beneficiaries newly diagnosed with cancer, 2.1% switched into traditional Medicare in states with both community rating and guaranteed issue, 1.1% switched in states with community rating only, and 0.8% switched in states with no Medigap protections. The odds of disenrollment were higher in states with both community rating and guaranteed issue (odds ratio [OR], 2.73 [95% CI, 2.53 to 2.94]; <i>P</i> < .001) and states with community rating only (OR, 1.48 [95% CI, 1.30 to 1.68]; <i>P</i> < .001), compared with states with no protections. MA beneficiaries with newly diagnosed cancers had higher rates of disenrollment from MA into traditional Medicare when state-level Medigap consumer protections were present. Beneficiaries appear more likely to switch if states make it financially easier to obtain Medigap.