Health insurance coverage patterns before and after a cancer diagnosis: Findings from adult patients with cancer in an integrated health system.

Abstract

262 Background: Patients diagnosed with cancer experience intense medical care and high costs associated with the disease and its treatment. As a result, patients may consider changes to their health insurance coverage to adjust the medical benefits covered and/or the cost-sharing (e.g., annual maximum out-of-pocket [MOOP] limit) requirements. The purpose of this study was to assess the patterns of health insurance plan coverage patterns prior to and following a diagnosis of cancer among adult patients. Methods: Data from 13,237 patients aged ≥18, enrolled at Kaiser Permanente Northwest, diagnosed with cancer between Jan. 1, 2016–March 31, 2021 [index cancer], with ≥12 months of continuous health insurance coverage pre-cancer diagnosis were included. Patients enrolled in hospice prior to index cancer were excluded. Health insurance coverage outcomes included (1) coverage patterns (maintenance, interruption, termination, switch); (2) a composite of any coverage changes; and (3) cost-sharing patterns. Monthly health plan membership enrollment data was used to assess outcomes between two time periods: pre-diagnosis (12 months prior to index cancer) and post-diagnosis (12-18 months following index cancer). Patient sociodemographic, enrollment, health plan and clinical data were extracted from the electronic health record (EHR). Descriptive statistics were used to assess outcomes. Results: Approximately 40% of patients were ages 18-64, 54% were female and 9% were non-White. At index cancer diagnosis, 60% of patients had Medicare, 37% had a commercial plan and 3% had Medicaid. Among patients aged 18-64, 62% had any change in health insurance coverage between pre- to post-cancer diagnosis, including 41% who switched plans, 19% who terminated and 2% with an interruption. Among patients aged 65+, 50% of patients had any change in health insurance coverage, including 20% who switched plans, 30% who terminated and < 1% with an interruption. For those who switched plans between the pre- to post-diagnosis periods, the most common patterns included switching out of commercial plans (-11% points) and switching into either Medicare (+9% points) or Medicaid (+5% points). Among all patients, 14% changed to a higher cost-sharing plan (difference in mean individual, in-network MOOP limit: $938) and 10% changed to a lower cost-sharing plan (difference in mean individual, in-network MOOP limit: -$1701). Conclusions: Our novel findings provide valuable information about health insurance plan coverage patterns among adults diagnosed with cancer and suggest a large proportion of patients may undergo changes to their health insurance coverage. Future studies that assess the implications of health insurance changes on care access and cancer outcomes are warranted.