Supplemental Benefits Offer Few Advantages for MA Enrollees

Even though almost all Medicare Advantage (MA) plans boast coverage of supplemental benefits — dental, vision, and hearing — enrollees didn’t get more care, and they spent just as much out of pocket as those with traditional Medicare, a cross-sectional study showed.

MA and traditional Medicare enrollees had “virtually identical” rates of using hearing aids (13.4% and 13.2%), wearing eyeglasses (78% and 76.8%), and having an eye exam in the past year (53.5% and 53.6%), according to Christopher Cai, MD, of Brigham and Women’s Hospital in Boston, and colleagues.

While MA beneficiaries paid about 9% less out of pocket than traditional Medicare beneficiaries for eyeglasses ($205.86 vs $226.12) and dental visits ($226.82 vs $249.98), they paid no less for optometry visits or durable medical equipment (a proxy for hearing aids), they reported in JAMA Network Open.

They noted that the difference in dental out-of-pocket costs between MA and traditional Medicare was driven by payments for emergency dental visits ($374.93 vs $497.31, P=0.03).

“Supplemental benefits are a major draw to Medicare Advantage, but our findings show that people enrolled in Medicare Advantage have no better access to extra services than people in traditional Medicare, and that much of the cost comes out of their own pockets,” co-author Lisa Simon, MD, DMD, also of Brigham and Women’s Hospital, said in a statement. “Older adults and people with disabilities deserve better from Medicare.”

In 2023, MA plans enrolled more than half (51%) of Medicare beneficiaries. However, little is known about how MA enrollees use their supplemental benefits, which aren’t offered by traditional Medicare, or how much they spend on them. A 2024 Commonwealth Fund report found that 31% of MA enrollees hadn’t used their supplemental benefits in the past year, with 58% not using dental, 59% not using vision, and 93% not using hearing benefits.

For their study, Cai and colleagues assessed data on 76,557 Medicare beneficiaries from the 2017-2021 Medical Expenditure Panel Survey (MEPS) and the Medicare Current Beneficiary Survey.

They found that many MA beneficiaries weren’t aware that they had dental (54.2%) or vision (54.3%) coverage.

The lack of awareness of coverage could be one reason why MA enrollees didn’t use more care than traditional Medicare beneficiaries, the researchers said. Or, it could have to do with the barriers posed by cost-sharing imposed by MA plans, which covered only a quarter of the total costs for these supplemental services.

Indeed, MA plans spent $3.9 billion annually on vision, dental, and durable medical equipment, while enrollees spent $9.2 billion out of pocket — accounting for 24.5% and 57.9% of total spending, respectively. The remaining $2.8 billion was picked up by other private insurances, the researchers noted.

Cai and colleagues pointed out that during the study period, MA plans were paid $37.2 billion each year more than taxpayers would have spent on traditional Medicare for those enrollees (a figure that’s expected to now total $82 billion annually). Only about 10% of that cost (the $3.9 billion) went to MA enrollees as payments for supplemental services, they said. Instead, a recent study showed that insurer overhead and profit accounted for a far larger share of those overpayments.

The study was limited by several factors, including that patients in MA plans may differ from those in traditional Medicare in ways not captured by adjusted analyses; that MEPS underestimates medical expenditures; and that the researchers lacked data on premium payments, which may be higher among traditional Medicare beneficiaries.

Still, they called for expanding supplemental benefit coverage and use for all Medicare beneficiaries — which could be funded “by reducing or eliminating overpayments to MA insurers.”