Medicare Advantage Linked to Lower Access to High-Quality Cancer Surgery in US
Key Takeaways
- Medicare Advantage (MA) beneficiaries were less likely to undergo major cancer surgery at high-quality hospitals.
- Differences in treatment access persisted even after accounting for travel burden, indicating that reduced use of high-quality hospitals among MA enrollees was not solely driven by geography.
- Findings highlight network design as a potential barrier to optimal surgical cancer care in the US.
Enrollment in MA now includes more than half of all Medicare beneficiaries in the US, yet its impact on access to high-quality cancer surgery has been uncertain. A large national cohort study using Medicare claims data found that MA enrollment was associated with reduced likelihood of undergoing major cancer surgery at high-quality hospitals, raising concerns for oncology care delivery and pathway design.
Study Findings
The retrospective cohort study analyzed Medicare Provider Analysis and Review data from January 2016 through November 2022, including 567 770 beneficiaries who underwent elective surgery for 8 solid tumors: esophageal, pancreatic, liver, gastric, bladder, colon, kidney, or prostate cancer. Data analysis occurred between August 2024 and July 2025.
Of the cohort, 216 323 patients were enrolled in MA, and 351 447 patients were enrolled in traditional Medicare (TM). MA enrollment increased substantially over the study period, from 32% of beneficiaries in 2016 to 46% in 2022. Compared with TM beneficiaries, MA enrollees were more likely to live in socially vulnerable areas, have a higher burden of comorbidities, and receive care at nonteaching hospitals.
Hospital quality was defined using procedure-specific, risk- and reliability-adjusted mortality rates, with hospitals ranked into quintiles. High-quality hospitals were those in the lowest mortality quintile. Across all cancer types, MA enrollment was associated with a lower likelihood of surgery at these high-quality centers.
For example, 21.7% of TM beneficiaries undergoing esophagectomy received care at a high-quality hospital, compared with 17.3% of MA enrollees. Similar differences were observed for pancreatectomy, with 22.6% of TM patients treated at high-quality hospitals vs 16.2% of those in MA. TM beneficiaries were also consistently more likely to bypass a closer, lower-quality hospital to receive care at a higher-quality center.
Clinical Implications
High-volume, high-quality hospitals have long been associated with lower mortality for complex cancer surgeries, supporting regionalization of care for procedures such as esophagectomy and pancreatectomy. Despite this evidence, many complex operations continue to be performed at low-volume centers, even after accounting for geographic distance.
The study’s findings suggest that MA plan networks may influence where patients receive surgical oncology care, potentially limiting access to hospitals with the best outcomes. For oncologists and oncology pathway leaders, these results underscore the importance of considering insurance design when evaluating care variability and outcomes.
For oncology payers and health system leaders, the data raise questions about network adequacy and whether current MA structures align with evidence-based recommendations for regionalized cancer surgery. As MA enrollment continues to grow, ensuring access to high-quality surgical centers may be critical to maintaining outcomes and equity in cancer care delivery across the United States.
According to the authors, these patterns suggest that “current MA plan networks may limit access to optimal surgical care,” raising broader concerns about cancer care delivery under privatized Medicare in the United States.
Conclusion
In a national analysis of more than half a million patients, MA enrollment was associated with reduced access to high-quality hospitals for major cancer surgery. As MA continues to expand, policymakers, payers, and oncology leaders may need to reassess network design to support high-quality, evidence-based surgical cancer care.
Reference
Maganty A, Liu X, Dall C. Surgery at high-quality hospitals among Medicare Advantage beneficiaries undergoing cancer surgery. JAMA Surg. 2025;160;(12):1341-1347. doi:10.1001/jamasurg.2025.4320
