Most Medicare Advantage (MA) plans offer some kind of supplemental benefit, but data on how—and if—members are using them are scant, according to a new report.
The Government Accountability Office (GAO) analyzed nearly 3,900 MA plans from all 50 states and the District of Columbia and found that all but one offered at least one supplemental benefit. The most common was vision coverage, offered by 98% of plans, followed by hearing coverage, which was offered by 94%.
Less common were benefits that plans only recently secured the necessary flexibilities to include. Seventeen percent of plans included in-home support services, and 6% provided support for caregivers, options that were first available in 2019.
Food and produce benefits were offered in 15% of plans, and meals beyond a limited basis were offered in 7%, both of which could first be offered in 2020.
"MA plans decide which, if any, supplemental benefits to offer," GAO wrote in the report. "These benefits may be attractive to Medicare beneficiaries, but little is known about their use."
MA plans are required to report information on utilization, known as encounter data, to the Centers for Medicare & Medicaid Services (CMS), though the data on supplemental benefits are limited. The analysis identified two reasons.
For one, while plans are required to submit encounter data on each enrollee, guidance does not specify supplemental benefits. CMS officials told GAO that the guidance is clear that such data are required, however, leaders at three MA plans said they do not submit data on supplemental benefits because they are not required to do so.
In addition, officials at both CMS and MA organizations acknowledged there are barriers to gathering and submitting data on certain supplemental benefits. For example, there is currently no procedure code available for new options like food and produce.
"As of October 2022, CMS was in the early stages of assessing the completeness of the encounter data for supplemental benefits and identifying options for collecting enrollee utilization data for the newer benefits but did not have a workplan or timeline for next steps," GAO wrote in the report.
"More complete information on enrollees' use of supplemental benefits would put CMS in a stronger position to ensure the benefits effectively support the health and social needs of enrollees," the organization added.
GAO made two recommendations to CMS on how to strengthen encounter data available on supplemental benefits. It suggests clarifying guidance on whether submitting such data is required and addressing scenarios where a procedure code for certain benefits may not exist.
HHS concurred with the recommendations, according to the report.