Medicare Advantage (MA) overpayment allows plans to funnel more money into supplemental benefits, appealing to enrollees who want or need the additional coverage. Some of these benefits, like dental, hearing, and vision coverage, are important for beneficiary health and well-being. But what a benefit looks like on paper may not be what MA enrollees experience.
Value and Accessibility of Supplemental Benefits Remains Unclear
Medicare Rights frequently hears from individuals who enrolled in a plan based on promised supplemental benefits, only to find those benefits more limited or harder to access than anticipated. Our ability to assess the scope of the problem is, however, limited because there are not enough data on supplemental benefit use and availability. Questions like whether MA insurers offer adequate networks to access the services, whether they are of value to plan members, and whether plan marketing tactics are appropriate cannot be answered without more and better information being made publicly available.
Our ability to assess the scope of the problem is, however, limited because there are not enough data on supplemental benefit use and availability
Medicare Beneficiaries Struggle to Evaluate Supplemental Benefit Offerings
A recent Health Affairs Forefront article from Justice in Aging and the Medicare Rights Center describes the difficulties people with Medicare have when trying to weigh supplemental benefit offerings from MA plans. Potential enrollees do not have enough information about their eligibility for benefits, their scope and limitations, how to access them and, for people who are dually enrolled in Medicare and Medicaid, whether MA supplemental benefits will coordinate with, duplicate, or even hamper access to Medicaid benefits.
Supplemental Benefits May Overshadow Plan Limitations in Beneficiary Decisions
Some of the most attractive supplemental benefits might convince people to sign up even when the rest of the plan is not the best fit for their healthcare coverage needs or without understanding other plan rules and restrictions. For example, someone struggling financially might find debit cards that can help pay for utilities or groceries very appealing, but such benefits might look better on paper than they truly are. And signing up for the wrong plan can have severe repercussions. Enrollees might lose access to their preferred providers, face more prior authorization hurdles, or discover their medications are not on a plan’s formulary.
Plan Selection Should Be Clarified and Supported
At Medicare Rights, we continue to urge policymakers to make choosing a plan easier through better access to assistance, clearer information, and standardized benefits that allow apples to apples comparisons. Each of these improvements is vital as people make coverage choices that can affect their health and financial security.
Read the article.
Read more about the need for dental, hearing, and vision coverage in Medicare.
