Medicare and Cancer Care Reform: Closing the Gaps in Access and Affordability

J Clin Pathways. 2025;11(6):33-34.

Youngmin Kwon, PhD, a postdoctoral fellow in health policy at Vanderbilt University School of Medicine, discusses how Medicare eligibility at age 65 helps reduce financial barri­ers to care for patients with cancer and cancer survivors, why disparities persist, and what policy changes could further improve equity and affordability for this population (Figure). The following is an edited excerpt from the inter­view for clarity and brevity.

Youngmin Kwon, PhD: I am a postdoctoral fellow in health policy at the Vanderbilt University School of Medicine. My research examines access and affordability care for patients with cancer and cancer survivors, with a focus on the role of Med­icaid and Medicare programs in alleviating financial barriers to care that patients with cancer face.

Your study shows a sharp drop in delayed or skipped care at age 65 with Medicare eligibility. From your perspec­tive, what aspects of Medicare most directly enable older cancer survivors to access needed care, and where do you see the biggest remaining gaps?

Dr Kwon: In our health care system, the primary source of insurance coverage for younger adults is employers, which fun­damentally creates many gaps in coverage. In the context of cancer survivorship, a major concern is a survivor’s ability to work may be impacted by cancer, which may result in lapses in employer-sponsored coverage. In such cases, unless you qualify for Medicaid or can afford private insurance in the Affordable Care Act Marketplace, there are likely no other sources of cov­erage and thus many may remain uninsured. Even among the insured, there are concerns about under-insurance.

In comparison, the story is much simpler on the Medicare side. It’s a program you’re entitled to receive, and even though it is not perfect coverage, the continuity of the benefit and fewer restrictions in care (especially if you’re in Traditional Medicare) may contribute to improvements in access and affordability.

Even with near-universal Medicare coverage, nearly 30% of older cancer survivors still face affordability or access challenges. What factors within the broader cancer care system do you see as driving these persistent financial bur­dens, and how might policy better address them?

Dr Kwon: On the Medicare side, the foremost challenge is how to best ensure that beneficiaries can meet the confluence of health care needs that arise from cancer diagnosis.

For those who are recently diagnosed with cancer, they may wrestle with cost of cancer-directed treatments, which has been increasing across the board. Treating cancer also entails many inpatient and outpatient visits, which can be costly and burden­some. Coordinating all these services in a financially sustainable manner can be difficult.

Long-term cancer survivors who are in remission also ex­perience unique needs for care. In general, long-term survi­vors tend to have more comorbidities which may generate higher care needs compared to the general Medicare popula­tion. Furthermore, survivors need to be monitored for cancer recurrence, which involves ongoing access to diagnostic and screening services.

Do you see differences in how Medicare reduces access barriers for different subgroups of older cancer survivors (eg, racial and ethnic minorities, rural vs urban popula­tions, and low-income individuals)? If so, what targeted solutions might help ensure equity in access?

Dr Kwon: We do find that the benefits of Medicare eligibility are more pronounced among the subgroups mentioned, partic­ularly racial and ethnic minorities and those with lower levels of education. Those are the groups that likely have less access to insurance before they are age-eligible for Medicare. That reaf­firms the value of Medicare as a near-universal program.

Among younger adults, major insurance expansions—such as Medicaid expansion and improving the ACA marketplace— have been pivotal in addressing gaps to coverage. Further building upon these expansions would be greatly important to ensuring equity.

Given your findings, what reforms to Medicare—or com­plementary policies—do you think would be most im­pactful in further reducing cost-related barriers for cancer survivors?

Dr Kwon: Even within Medicare, there is a lot of variability in access and affordability, which reflect differences in how ben­eficiaries receive Medicare benefits.

In Traditional Medicare, beneficiaries face few or no re­strictions in care, but they are responsible for high cost-shar­ing without protections for catastrophic costs. To reduce or eliminate such costs, many beneficiaries obtain supplemental coverage, such as Medigap private supplemental insurance. However, purchasing supplemental coverage means paying for additional monthly premiums that may not be affordable for everyone.

The other type of Medicare coverage is Medicare Advan­tage, a managed care alternative to Traditional Medicare. While out-of-pocket costs may be lower with Medicare Advantage, there are restrictions in access to care. Among cancer survivors, there have been frustrations with limited provider networks and prior authorization process.

Overall, there are important trade-offs in access and afford­ability between these two coverage options.

Based on your findings, how do you see access and afford­ability for older cancer survivors evolving over the next 10 to 15 years?

Dr Kwon: After decades of research, many stakeholders in the system are now keenly aware of the financial toxicity of cancer care. Researchers have been doing a stellar job of documenting the extent to which patients experience financial toxicity and studying interventions to alleviate financial toxicity.

Moving forward, we’re still going to be wrestling with how to pay for costly cancer care. With newer medical innovations coming along, cancers can be treated more effectively, but there will always be concerns about access and affordability.

Obviously, insurance is a key mechanism to facilitate access to treatments, but how to design coverage in a way that is af­fordable and financially sustainable for the Medicare program is a tough question.

On the other hand, we need more research on access to cancer care in Medicare Advantage, which now covers more than half of Medicare beneficiaries. Further research in these domains will be valuable to policymakers and other stake­holders who are constantly discussing ways to reform the Medicare program.

Read the full interview here.