Background: The Medicare Advantage (MA) program provides care to nearly half of Medicare beneficiaries, including a rapidly growing population of cancer survivors. Although MA was designed to optimize healthcare access, outcomes, and affordability, it is unknown whether these effects have been achieved in cancer survivors. Methods: We performed a cross-sectional study of Medicare beneficiaries ≥65 years with a self-reported history of cancer in the 2019 National Health Interview Survey. We used multivariable logistic regression to evaluate the association between Medicare program type (MA vs traditional Medicare, TM) and measures of healthcare access, acute care utilization, and affordability. Results: We identified 4,451 beneficiaries with a history of cancer, corresponding to 26.6 million weighted cancer survivors in 2019. Of beneficiaries, 35.8% were enrolled in MA while 64.2% were enrolled in TM. The age, sex, racial and ethnic composition, household income, primary site of cancer, and co-morbidity burden of MA and TM beneficiaries were similar. In adjusted analysis, there were no differences in health care access or acute care utilization between TM and MA beneficiaries. However, survivors enrolled in MA were more likely to worry about (34.3% vs 29.4%; aOR, 1.3 [95% CI, 1.1-1.5]) or have problems paying (13.6% vs 11.1%; aOR, 1.4 [95% CI, 1.1-1.8]) medical bills. Conclusions: MA beneficiaries with a previous cancer diagnosis more often struggle paying medical bills despite similar healthcare access and preventive care as TM. Despite generous benefits and attractive incentives for care coordination and health management, privately run MA plans may not be more cost-effective than TM for cancer survivors. Our study informs ongoing congressional deliberations to re-evaluate the role of MA in promoting equity among beneficiaries.

ORs presented with TM as reference. ^a Percent answering yes. ^b Adjusted for age, sex, education, race/ethnicity, annual income, primary site of cancer, number of chronic diseases, region of residence, metropolitan status & survey year.