Medicare Advantage Linked to Higher Hospice Use in Advanced Cancer Patients

Why It Matters

Higher hospice utilization under MA signals that plan incentives can improve end‑of‑life care, but persistent racial and income gaps raise equity concerns for policymakers and payers.

Key Takeaways

• Continuous Medicare Advantage yields highest hospice enrollment (74.8%).
• Switching plans adds 2‑3 percentage points to hospice use.
• Black and Hispanic patients enroll less often in hospice.
• MA enrollees more likely to receive home hospice care.
• Socioeconomic status influences plan‑switching patterns.

Pulse Analysis

Medicare Advantage’s growing market share has reshaped how beneficiaries experience end‑of‑life care. The recent JAMA Network Open analysis, covering nearly 200,000 advanced‑cancer decedents, shows that MA enrollees are 6.9 percentage points more likely to enter hospice in their final year than those on traditional Medicare. This advantage extends to longer hospice stays—averaging 48.3 days versus 43.8 days for TM—and a higher propensity for home‑based hospice, reflecting MA’s coordinated care networks and supplemental benefits that facilitate earlier referrals.

However, the data also expose deep inequities. Non‑Hispanic Black beneficiaries enrolled in hospice 8.5 percentage points less than White peers, and Hispanic patients lag by 2.6 points. Socioeconomic factors further drive plan switching, with lower‑income and minority patients more frequently moving from MA to TM, potentially forfeiting the hospice gains associated with continuous MA coverage. These disparities underscore how financial incentives, benefit designs, and social determinants intersect, influencing not only enrollment rates but also the quality and setting of hospice services.

Policymakers and health systems must address these gaps to ensure equitable end‑of‑life care. Future research should explore care‑coordination mechanisms within MA that promote timely hospice referrals while identifying barriers faced by vulnerable groups. Targeted interventions—such as culturally tailored outreach, enhanced dual‑eligibility support, and transparent cost‑sharing structures—could mitigate the observed disparities and harness MA’s strengths to improve hospice access across the Medicare population.