Are Medicare Advantage Plans Using New Supplemental Benefit Flexibility to Address Enrollees' Health-Related Social Needs?

Medicare Advantage Plans can expand non-medical benefits, but barriers remain.

The Issue

As of March 2019, Medicare Advantage (MA) plans covered more than one-third of Medicare beneficiaries, or 22 million people in America. Before the 2019 plan year, supplemental benefits funded by rebates had to be items or services not covered by Medicare, were primarily health related, and incurred a direct medical cost for the MA plan. Recent policy changes by the Centers for Medicare and Medicaid Services mean that MA plans can now cover non-medical services that impact beneficiaries’ health. Some plans are using the new flexibility around supplemental benefits to provide or expand transportation benefits, home-delivered meals, and personal care services.

Key Findings

• In a series of 10 interviews with Medicare Advantage plans, health insurance experts and social service providers, researchers found plans were supportive of new benefits but were reluctant to expand offerings rapidly. They say most Medicare Advantage plans expanded benefits in piecemeal fashion, most often addressing meal delivery and adult day care.

   

Conclusion

According to report authors, no new funding was provided to cover these new benefits, limiting plans’ incentive to expand services. Because of the Medicare Advantage funding formula, available resources for providing these new benefits vary widely from state to state and, especially, county by county. In addition, these new benefits are not available to the two-thirds of Medicare beneficiaries who are not enrolled in Medicare Advantage.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.

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