Policy Experts on Reforming Medicare Advantage Supplemental Benefits

Medicare Advantage plans often offer supplemental benefits that Original Medicare does not cover such as vision, hearing, and dental services, making Medicare Advantage plans an attractive option for healthcare coverage.  

The Center of Medicare and Medicaid Services (CMS) expanded the definition of supplemental benefits in 2018 and 2019. In 2018, the definition expanded to include services that improve health and quality of life such as non-skilled in-home supports. In 2019, regulations included the creation of Special Supplemental Benefits for the chronically ill, covering benefits that support, such as food benefits, transportation, and financial support. Medicare Advantage plans choose which supplemental benefits to provide, along with cost sharing and coverage limitations for them. 

Below we have outlined what policy experts are saying about reforming various aspects of Medicare Advantage supplemental benefits, including accessibility, marketing, evaluation, and the overlap between Medicaid benefits.  

WHAT POLICY EXPERTS SAY ABOUT SUPPLEMENTAL BENEFIT MARKETING 

 Supplemental benefits vary across Medicare Advantage plans, which makes it difficult for individuals to compare and decide which Medicare Advantage plan they want to enroll in. To add to the confusion, Medicare Advantage plans market supplemental benefits aggressively, but their marketing materials usually do not present eligibility criteria and coverage limitations for supplemental benefits in an accessible way. 

Policy experts recommend standardizing supplemental benefits (much like how Medigap benefits are standardized) to make MA plan marketing and MA plan comparison more accessible.  

WHAT POLICY EXPERTS SAY ABOUT MONITORING AND EVALUATING SUPPLEMENTAL BENEFIT USE 

Medicare advantage plans must report how often supplemental benefit services are used. However, a federal audit found that plans failed to consistently report supplemental benefit use. Most supplemental benefits are social services without standardized billing codes, making it difficult to monitor supplemental benefit use. Additionally, CMS requires no other monitoring of supplemental benefits. These challenges limit national evidence on how supplemental benefits affect health outcomes.  

Policy experts urge better monitoring of supplemental benefit uses. CMS’ final rule has made some progress by requiring plans to report specific data on how many enrollees are eligible for a supplemental benefit, enrollees who used the benefit, total utilization instances, and the total cost. Additionally, the final rule states that by 2026, plans must send beneficiaries a notice midway through the year about any unused supplemental benefits. The new requirement mandates Medicare Advantage plans track and report what supplemental benefits enrollees use.  

WHAT POLICY EXPERTS SAY ABOUT THE OVERLAP OF SUPPLEMENTAL BENEFITS AND MEDICAID BENEFITS 

Dually eligible individuals, those enrolled in Medicare and Medicaid, can choose to enroll in Medicare Advantage Dually Eligible Special Needs Plans (D-SNPs). Some supplemental benefits offered by D-SNPs overlap with those offered through Medicaid, such as dental, vision, and hearing coverage. The overlap of benefits can confuse D-SNP enrollees because they do not receive double benefits and must navigate which insurance covers the benefit. Additionally, Medicare and Medicaid have different provider networks and coverage limitations for services they both cover. For example, Medicare only covers stays in home or adult day center services on a short-term basis, while Medicaid can cover these services on a long-term basis. Policy experts call for more transparency on how supplemental benefits and Medicaid benefits overlap. One recommendation is to put information on Medicaid benefits on the Medicare.gov Planfinder, allowing individuals to better understand and compare the benefits they would receive.   

States can leverage their State Medicaid Agency Contract (SMAC) to unify the supplemental benefits provided by D-SNPs, requiring coordination with Medicaid benefits. This could help alleviate the confusion for beneficiaries.   

MORE ON MEDICARE ADVANTAGE SUPPLEMENTAL BENEFIT REFORM 

Avisery suggests our blog readers may find it interesting to visit this Health Affairs series focusing on Medicare Advantage supplemental benefits. The series’ articles track changes in the policy landscape on supplemental benefits and offer various perspectives. Avisery is especially interested in topics that affect duals in anticipation of the upcoming Illinois transition to D-SNPs. We will be monitoring to see if any studies can assist in our advocacy.