A cross-sectional study revealed Medicare Advantage beneficiaries do not use vision, dental, or hearing benefits at higher rates than those enrolled in traditional Medicare. Despite having broader coverage, barriers such as cost-sharing, limited awareness, and network restrictions appear to hinder use of these supplemental services.
The study, recently published in JAMA Open Network, analyzed 76,557 non-dually eligible Medicare beneficiaries from the Medicare Current Beneficiary Survey (MCBS) and Medical Expenditure Panel Survey (MEPS) for the years 2017 through 2021. There were 23,404 Medicare Advantage (MA) beneficiaries and 53,153 traditional Medicare (TM) beneficiaries included in the study.
More than half of MA beneficiaries reported dental and vision coverage (54.2% and 54.3%, respectively), while 7.2% had additional private vision coverage. Of these enrollees, 53.5% used their eye exam service and 78% used their corrective lens service. These rates of usage were similar for TM enrollees. More than 40% of MA enrollees were unaware of their vision or dental benefits.
In contrast, 17.4% of TM beneficiaries had private vision coverage and 34.2% had private dental coverage. Hearing aid use among those with hearing loss was comparable between groups.
MA enrollees paid approximately 9% less out of pocket for services—eyeglasses were $206 for MA beneficiaries and $226 for TM beneficiaries, while dental visits were $227 for MA and $250 for TM. Both groups incurred high out-of-pocket costs for supplemental services, for which enrollees paid more than half of the cost out of pocket. MA plans spent $3.9 billion annually on supplemental benefits, covering 24.5% of the total cost, while TM spent $1.6 billion annually, which accounted for 6.4% of total expenditures for supplemental benefits.
The researchers also investigated overpayments and found that “MA plans spent approximately $200 annually per capita (approximately $145 more than TM) on supplemental benefits between 2017 and 2021, equivalent to 1% to 2% of total MA spending. During the same period, MA plans were paid, on average, $37.2 billion more annually than taxpayers would have spent had MA enrollees remained in TM (with overpayments expected to rise to $82 billion in 2024). Approximately 10% of those overpayments, $3.9 billion, was passed on to MA enrollees as payments for supplemental services.”
They suggested that reduced overpayments could fund a mid-year reminder letter that outlines enrollees’ unused benefits, an initiative proposed by the Centers for Medicare & Medicaid Services. Such a reminder may help to close the gap between enrollment and the use of services, especially for enrollees with unmet dental, vision, and hearing needs.
A full list of author disclosures can be found in the published research
