Characteristics of Hospices in the 2025 South Carolina ACA Marketplace

• In Event: From Coverage to Care: Networks, Cost-Sharing, and Access

Abstract

Background:  The Affordable Care Act requires insurers to contract with hospices as part of the Essential Health Benefit requirement.  To date, little is known about hospice contracting in ACA marketplace plans.  We assess the characteristics of hospices in the South Carolina ACA marketplace in 2025 using CMS data. 

Objective: This study describes the association of hospice characteristics and contracting status in the 2025 South Carolina ACA individual marketplace by Quality Star status and CAHPS scores and components.   Data:  We matched all hospice-insurer-network level participation from public web directories in October 2025 to CMS CAHPS and Star Ratings.  Ninety one hospices are licensed in South Carolina, and sixty five contract with at least one insurer-network dyad.  CAHPS and Quality Star ratings were sourced from the Centers for Medicare and Medicaid Services for 2025 and 2026 and linked at the hospice-level. 

Methods:  We used descriptive statistics including Chi Squared and t-tests to compare hospices that have contracts with ACA insurers and those without contracts on their CAHPS scores and star ratings.  We conducted a multi-variate probit regression analysis to assess the characteristics of hospices that contracted with the ACA insurers at various levels of intensity.  We assessed whether contracting status has a strong association with concurrent or retrospective quality score measures.

Results: No final results available at this time, analyses are in progress.  Descriptive results suggest that higher quality hospices are more likely than lower quality hospices to have any ACA contract.  Additional analyses will explore the the intensity of contracting and quality conditional on any contracting.

Policy Implications:  Hospices are a key Essential Health Benefit regulated by states.  Understanding which hospices are included and not included in ACA individual market insurance networks will improve our understanding of network adequacy and access to high quality care for patients at the end of life.

Author

• David Anderson, University of South Carolina
  Presenting Author