12/12/2023 0 Comments Medicaid out of pocket expensesFinancial distress may also discourage use of effective services, including poor adherence to key anticancer therapies. Indeed, reports have increasingly documented the adverse consequences of cancer on patients’ financial well-being, including depleted savings and even bankruptcy. Moreover, more than 4 million Medicare beneficiaries lack supplemental insurance altogether and may be particularly vulnerable following a major diagnosis, such as cancer. Medicare beneficiaries who obtain their benefits through a health maintenance organization (HMO) face similar variation in the design of benefits. Although supplemental coverage through Medigap, employer-sponsored insurance, or Medicaid can minimize OOP costs, considerable heterogeneity exists in the design of benefits, placing seniors at variable financial risk. However, traditional Medicare also requires considerable cost sharing from its beneficiaries and does not include an out-of-pocket (OOP) maximum. As most new cancers and cancer-associated deaths occur in adults older than 65 years, much of this cost burden will be borne by Medicare, the federal health insurance program for the elderly and disabled. Moreover, annual direct medical expenditures on cancer are projected to increase by nearly 40% from 2010 to 2020, largely owing to a combination of changing demographics, increased use of services, and expensive new treatments. Among the 10% of beneficiaries with cancer who incurred the highest OOP costs, hospitalization contributed to 41.6% of total OOP costs.Īmong the 5 health conditions that contribute most to health care costs in the United States, per-person direct medical expenditures on cancer are the highest. Beneficiaries with a new cancer diagnosis and Medicare alone incurred OOP expenditures that were a mean of 23.7% of their household income 10% of these beneficiaries incurred OOP expenditures that were 63.1% of their household income. A new diagnosis of cancer or common chronic noncancer condition was associated with increased odds of incurring costs in the highest decile of OOP expenditures (cancer: adjusted odds ratio, 1.86 95% CI, 1.55-2.23 P < .001 chronic noncancer condition: adjusted odds ratio, 1.82 95% CI, 1.69-1.97 P < .001). Previous Presentations: Portions of this work were presented in abstract form at the 2015 American Society for Clinical Oncology Annual Meeting JChicago, Illinois and the 2015 American Society for Therapeutic Radiation Oncology Annual Meeting OctoSan Antonio, Texas.Īmong the 1409 participants (median age, 73 years 46.4% female and 53.6% male) diagnosed with cancer during the study period, the type of supplementary insurance was significantly associated with mean annual OOP costs incurred after a cancer diagnosis ($2116 among those insured by Medicaid, $2367 among those insured by the Veterans Health Administration, $5976 among those insured by a Medicare health maintenance organization, $5492 among those with employer-sponsored insurance, $5670 among those with Medigap insurance coverage, and $8115 among those insured by traditional fee-for-service Medicare but without supplemental insurance coverage). Role of the Funder/Sponsor: The funding source did not have a role in the design and conduct of the study collection, management, analysis, and interpretation of the data preparation, review, or approval of the manuscript or decision to submit the manuscript for publication. doi:10.1001/jamaoncol.2016.4865Īuthor Contributions: Dr Narang had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.Īcquisition, analysis, or interpretation of data: Both authors.Ĭritical revision of the manuscript for important intellectual content: Both authors.Īdministrative, technical, or material support: Nicholas.Ĭonflict of Interest Disclosures: None reported.įunding/Support: Dr Nicholas is supported by career development award K01AG041763 from the National Institute on Aging. Narang, MD, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, 401 N Broadway, Ste 1440, Baltimore, MD 21231 ( Online: November 23, 2016.
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