The challenges preventing Medicare Advantage plans from going all-in on supplemental benefits 

Medicare Advantage
A new report explores challenges faced by Medicare Advantage plans in offering supplemental benefits targeting the social determinants of health. (Getty/designer491)

Medicare Advantage (MA) insurers want to offer supplemental benefits but warn that the additional flexibilities offered by the feds may not be enough to really target beneficiaries, a new report shows. 

The Centers for Medicare & Medicaid Services (CMS) recently finalized new flexibilities to allow MA plan sponsors to offer nontraditional benefits that target the social determinants of health such as air quality tools, transportation and meals for the 2020 plan year. CMS broadened those options beginning in the 2019 plan year

Researchers at the Urban Institute conducted a series of interviews with MA insurers, health insurance experts and social services providers that highlighted several barriers to embracing benefits that target the social determinants of health: funding challenges and struggles in targeting the right beneficiaries. 

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Laura Skopec, senior research associate at the Urban Institute and one of the study’s authors, told FierceHealthcare plans are still working out which benefits are the most valuable for investment. 

RELATED: Why supplemental benefits in MA mark a 'turning point' for Medicare policy 

Due to those concerns, plans are starting with those that have low upfront costs such as meal delivery or small home modifications like grab bars in the shower, she said. 

“I think plans are interested and they want to be able to offer additional benefits that can help enrollees,” Skopec said. “But progress has been limited so far.”  

As CMS did not allocate additional funding for these benefits, health plans are stuck with limited financial resources to try supplemental benefits, the report noted. 

To pay for supplemental benefits, MA plan sponsors must pull from rebates CMS pays out to make up the difference between an insurers’ bid and the national benchmark, if the bid is below that marker. 

However, these rebates are often small, averaging about $107 per member per month in 2015, according to the study. Additionally, insurers pull from these funds for other efforts to lower cost-sharing or to cover benefits such as dental and vision care or gym memberships, which are popular with beneficiaries. 

RELATED: Offering Medicare Advantage supplemental benefits is a 'long play,' experts say 

“I think plans are reluctant to cut back those very popular benefits to add these untested benefits,” Skopec said. 

In addition, rebate values fluctuate widely based on geographic region. Insurers in Florida, for example, received $159 per member per month on average in 2015, while Georgia payers received an average of $48 per member per month. That can make it far harder for MA plan sponsors in certain regions to provide these additional benefits, according to the report. 

Payers also struggle to effectively target these benefits, as CMS wants them to target certain chronic conditions and not specific socioeconomic needs, according to the report. Allowing for more flexibility to identify and target specific beneficiary populations would make these benefits more useful and ensure investments are reaching the people that need them. 

Skopec added that another concern is that these benefits are only available in MA, which is a growing segment of the Medicare population but at present only represents about one-third of beneficiaries. 

Despite these challenges, insurers intend to continue trying these services, the report found. 

“I think that the flexibility to offer these new benefits is promising and will lead to some experimentation that will tell us a lot,” Skopec said. 

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