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Many MA Beneficiaries Have Dental, Vision or Hearing Benefits. But Access Gaps Remain, Study Shows

by | Oct 11, 2024 | Insurance Industry, Medicare Advantage

One of the key selling points of Medicare Advantage is the supplemental benefits plans can offer, especially extending coverage for dental, vision and hearing care that the traditional program doesn’t have.

However, a new study published in Health Affairs finds that while these benefits are common in MA, low-income beneficiaries still face significant access barriers to dental, vision and hearing services.

The researchers, led by a team from New York University, note that 90% of MA plans cover at least one of these benefits, and they’re generally funded by rebates from the Centers for Medicare & Medicaid Services that are paid to insurers. They then analyzed a nationally representative survey of MA enrollees conducted in 2018 and 2019 and found that 11% reported an unmet dental need, 4% had an unmet vision need and 2% had an unmet hearing need.
Lower-income beneficiaries were more likely than their counterparts with higher incomes to report challenges, even when the researchers accounted for the generosity of the benefits they had, according to the study.

“The high need for dental, vision, and hearing care among Medicare recipients drives the high demand for supplemental benefits,” said Avni Gupta, a health policy researcher who recently earned her Ph.D. in health policy and management from the NYU School of Global Public Health and is now working at the Commonwealth Fund.

“However, these added benefits are expensive for Medicare, which pays nearly $20 billion a year in rebates to Medicare Advantage insurers for supplemental benefits,” Gupta said.

The study also found that patients enrolled in plans with higher star ratings had fewer unmet needs for dental care, though this trend did not extend to vision or hearing care. That said, bonus payments from CMS for star ratings performance were not identified as the cause for improving dental care access, according to the study.

The researchers said that the data suggest policymakers should do more to ensure that supplemental benefit rebates paid to MA plans are linked to the value of those offerings. CMS should also be taking steps to monitor and track the quality and equity of supplemental offerings.

“As the popularity of Medicare Advantage plans continues to increase, there is a need for more accountability and better oversight on how rebate dollars are being used to improve equitable access to supplemental benefits covering services we all use and need, such as dental, hearing, and vision care,” said José A. Pagán, Ph.D., a professor and chair of the Department of Public Health Policy and Management at the NYU School of Global Public Health, in the press release.

“Good stewardship in rebate payments means that Medicare Advantage beneficiaries should get the highest possible value as a result of financial incentives,” he said.

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