SDOH, Nonmedical Supplemental Benefits Lacking for MA Dual Eligibles

Medicare Advantage plans that exclusively serve dual eligible beneficiaries offered more social determinants of health (SDOH) and nonmedical supplemental benefits than general Medicare Advantage plans, according to a study published in JAMA Network Open.

Previous regulatory changes have allowed Medicare Advantage plans to offer members nonmedical supplemental benefits that help address health-related social needs and social determinants of health.

Beneficiaries who are dually eligible for Medicare and Medicaid tend to have more health-related social needs and higher rates of chronic and disabling conditions. Dual eligible special needs plans (D-SNPs) exclusively serve this beneficiary population. Fully integrated dual eligible SNPs (FIDE-SNPs) also service dual eligibles and integrate care under a single managed care organization.

Researchers used public Medicare Advantage benefit package data from 2021 to determine the extent to which D-SNPs, FIDE-SNPs, and general Medicare Advantage plans offered nonmedical supplemental benefits.

Over 3.6 million dual eligibles were enrolled in Medicare Advantage plans in 2021. More than half of these beneficiaries (60.5 percent) were enrolled in D-SNPs, 7.8 percent were enrolled in FIDE-SNPs, and 31.7 percent were enrolled in general Medicare Advantage plans.

Out of 59 FIDE-SNPs, 25 plans (42.4 percent) offered at least one nonmedical supplemental benefit to members. These plans served 63.8 percent of all dual eligibles enrolled in FIDE-SNPs. Among the 485 D-SNPs, 150 plans (30.9 percent) offered at least one nonmedical supplemental benefit, accounting for 22.9 percent of dual eligible beneficiaries.

The share of general Medicare Advantage plans offering at least one nonmedical supplemental benefit was smaller at 14.6 percent, or 451 out of 3,089 plans. These plans accounted for 19.9 percent of dual eligible beneficiaries.

Although FIDE-SNPs had the greatest likelihood of covering supplemental benefits, these plans only accounted for a small share of all dual eligible beneficiaries.

Transportation services and food assistance were the most common nonmedical supplemental benefits offered among the Medicare Advantage plans.

Forty-one percent of FIDE-SNP beneficiaries were enrolled in plans covering food and produce benefits and 15.5 percent had the option of receiving nonmedical transportation services. In D-SNPs, 14.4 percent of dual eligibles were offered food and produce benefits and 8.5 percent were enrolled in plans offering nonmedical transportation services.

Among dual eligibles in general Medicare Advantage plans, 8.8 percent had plans that offered food and produce benefits, while 5.8 percent had coverage for transportation services.

Less than 10 percent of all dual eligible beneficiaries had plans that offered home-delivered meals, home modifications, and social services for individuals with chronic illnesses. Out of the 42 available supplemental benefits, 22 were offered to less than 1 percent of dual eligibles and eight were not provided by any plan.

Benefits not commonly offered included pet care services, thorough house cleaning, health education, social needs benefit, and in-home safety assessments. Counseling services, enhanced disease management, readmission prevention, and weight management programs were not covered by any of the Medicare Advantage plans.

The study results suggest that Medicare Advantage plans have the opportunity to expand nonmedical supplemental benefits for dual eligible beneficiaries.