GAO Digs Into Medicare Advantage Plans' Supplemental Benefits Offerings

News February 01, 2023 at 10:58 AM
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Most Medicare Advantage plans offer dental and vision benefits, many pay for some medical-related transportation, and some have added a smidge of home care.

Analysts at the U.S. Government Accountability Office explore the plans' supplement benefits offerings in a new look at the state of Medicare Advantage plan supplemental benefits data.

The 3,893 plans reviewed spent an average of just $27 per member per month on supplemental benefits.

Michelle Rosenberg, the GAO health care director, writes in a letter outlining the GAO's findings that the Centers for Medicare and Medicaid Services, the agency that oversees Medicare, is still developing a strategy for collecting supplemental benefits data.

"More complete information on the utilization of supplemental benefits could help CMS determine whether or to what extent they support the health and social needs of Medicare enrollees," Rosenberg writes in a letter outlining the GAO analysts' findings.

What It Means

In theory, new types of Medicare Advantage supplemental benefits could be a significant source of value for some retired clients.

In practice, it´s not yet clear from CMS data how well the new benefits work.

Medicare Advantage Basics

Medicare Advantage offers what looks like an alternative to Original Medicare coverage for 30 million enrollees.

Medicare Advantage plans use a combination of federal funding and enrollee premiums. They often hold costs down by contracting for low fees with "in-network providers," and they may also manage enrollees' use of care.

The plans contend that their approach improves the quality of the care and care outcomes.

Clients who are willing to spend more on premiums in exchange for freedom from provider networks or active care management can fill the gaps in Original Medicare coverage with private Medicare supplement insurance policies.

The GAO analysts who wrote the new report looked only at Medicare Advantage plans, not at Medicare supplement insurance policies.

Supplemental Benefits

CMS and federal law impose restrictions on the kinds of benefits ordinary Medicare Advantage plans can offer.

For years, plans have been able to offer some types of extra benefits, such as vision care, dental care and hearing care benefits.

In 2019, during the administration of former President Donald Trump, CMS began to let plans offer extra benefits that could reduce avoidable health care use. In 2020, the agency let plans add benefits that could improve or maintain the health or function of chronically ill enrollees.

GAO's New Report

The Bipartisan Budget Act of 2018 includes a provision that calls for the GAO to review the plans' supplemental benefits.

When conducting the review, the GAO focused on ordinary Medicare Advantage plans in the 50 states and the District of Columbia that serve individual enrollees and offer prescription benefits.

The team excluded special kinds of "Medicare Part C plans," such as employer-sponsored plans, Medicare-Medicaid plans and Program of All-Inclusive Care for the Elderly plans.

Here's a look at the percentage of enrollees in the plans reviewed that offered certain types of benefits to at least some enrollees in April 2022:

  • Routine eye exams: 99.1%
  • Fitness programs: 97.3%
  • Oral exams: 93.0%
  • Routine hearing exams: 90.9%
  • Meals for a limited time: 68.7%
  • Transportation for medical needs: 41.1%
  • In-home care services, such as help with eating, dressing and housework: 16.3%
  • Food and produce: 12.5%
  • Meals beyond a limited basis: 6.5%
  • Adult day health services: 0.7%

Data Challenges

Plans told the GAO that they have problems with reporting on some benefits to CMS because there are no procedure codes for some of the newer benefits, such as food purchase subsidies.

Another challenge is that CMS believes that plans are supposed to report on instances of enrollees using the new supplemental benefits, but many plans believe the usual CMS patient encounter reporting rules do not apply to the supplemental benefits, Rosenberg writes.

The GAO is recommending that CMS clarify the supplemental benefits use reporting rules and tell plans how to proceed when a benefit lacks a procedure code.

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