Join us on October 16, 2023, for our Annual Awards Event in New York City.
This week, the Governmental Accountability Office (GAO), a watchdog agency that works for Congress, released a report on Medicare Advantage (MA) supplemental benefits. The report found that most MA plans offer some supplemental benefits but that there are limited data on to what extent plan enrollees have been able to use new types of benefits and what effect those benefits have had on enrollees’ health and function.
MA plans have been able to offer some forms of supplemental benefits for decades, but two new types of benefits came into the market in 2019 and 2020. The 2019 expansion allowed plans to offer supplemental benefits that were not directly considered medical treatment but were primarily health related. Most of these benefits are, at least theoretically, available to all plan enrollees. As of 2020, plans could offer supplemental benefits to individuals with chronic conditions that were not primarily health related but had a reasonable expectation of improving or maintaining health or function. These benefits are only for plan enrollees who qualify.
MA enrollment has expanded greatly since 2019, and the extra benefits have played a significant role. The Commonwealth Fund estimates that 24% of people who opted for MA were drawn by the extra benefits. But it is unclear how many people who are choosing MA for those extra benefits are actually using them.
The GAO found that utilization data are very limited. MA plans have not been reporting on supplemental benefits, despite regulations that require those reports. In addition, even where plans are willing, there are some technical problems in collecting that data, including a lack of procedure codes for some of the benefits, like fresh foods.
The GAO recommended that the regulations and guidance for plans be clarified to ensure plans understand they are required to submit data on supplemental benefits and for procedure codes or a similar workaround to be added to ensure plans can report on the full scope of benefits offered. The Centers for Medicare & Medicaid Services (CMS) agreed with both recommendations.
At Medicare Rights, we have long been concerned that MA plans are not transparent about supplemental benefits and that they are being used more as a marketing tool than as a true benefit that improves the lives of enrollees. We hope this report will shine more light on the issue and will result in more complete data on the use and value of supplemental benefits.
Sign up to receive Medicare news, policy developments, and other useful updates from the Medicare Rights.