The article explores the limitations of Medicare Advantage plans in providing adequate dental, vision, and hearing care coverage for lower-income beneficiaries. It highlights the inequity in access to these essential healthcare services and the need for greater accountability and oversight in how rebate payments are utilized to improve coverage and value for Medicare Advantage enrollees. Medicare and Medicare Advantage are crucial topics in the ongoing discussion around healthcare accessibility and affordability in the United States.
Space is an Uneven Playing Field for Supplemental Benefits
Publication in the article that it reported from not only documented a significant inequity in dental, vision, and hearing benefit deployment among lower-income Medicare Advantage beneficiaries, but also how many impoverished enrollees access these services. Although some private insurance plans offer supplemental benefits, most people in such plans encounter very high out-of-pocket costs and are faced with going without needed care.
Overall, the researchers found that 10.8% of Medicare Advantage participants reported unmet dental needs, along with 4.1% who went without needed vision care and another 2.3% who could not afford required hearing care due to their financial constraints. This highlights the inadequacy of their supplemental benefits, which all too frequently do not adequately protect those needing help financially.
Impact of Plan Quality Ratings
The study also investigated the potential supply-side effect of Medicare Advantage plan quality ratings based on the CMS star rating system. Notably, the researchers concluded that plans with higher ratings were correlated to lower numbers of unmet needs for dental services — particularly among those with lower income.
However, this association was not seen for vision and hearing coverage. This casts doubt on the efficacy of CMS quality bonus payments designed to encourage plans to focus on offering supplemental benefits. In other words, the study appears to indicate that the current system is not doing a very good job connecting those financial incentives with whether or not beneficiaries actually receive quality supplemental care.
A Fairer Future
This article highlights the pressing need for more checks and balances in Medicare Advantage. With a longer history and no shortage of examples, it is important for CMS to keep in mind that—if the private plans banking on these rebates continue to take off—those rebate dollars being used to pay for supplemental benefits need to be well-deployed as well as fairly-passed throughout.
However, the researchers also signal that CMS must actively oversee supplemental benefits to ensure coverage, quality and equity for all Medicare Advantage beneficiaries. Thus, potential areas calling for concern could relate to refining the star rating measures to more accurately depict true patient-oriented outcomes of ancillary benefits and other considerations around how best to create incentives for plans to optimize needs of those in lower income and High Needs individuals.
Policymakers have a unique chance to fix these systematic shortcomings — and create a Medicare Advantage program that is accessible and fair in reality, not just on paper, for all older and disabled Americans.
