Medicare Advantage enrollees underuse supplemental benefits

Medicare Advantage plans often include supplemental benefits that are not typically covered by traditional Medicare, such as over-the-counter medication coverage or dental and vision benefits. However, a lack of awareness of these supplemental benefits, as well as barriers to accessing them, might mean that enrollees are underusing these benefits, survey data from The Commonwealth Fund found.

The Commonwealth Fund reached these conclusions by analyzing previously collected survey responses from a 2024 survey on the value of Medicare to determine whether a beneficiary's perception of various supplemental benefits is associated with their use of said benefits.

Eight out of ten Medicare beneficiaries across all plan types said they considered supplemental benefits important.

However, the perceived value of these benefits varied by the type of Medicare plan the individuals were enrolled in. Nearly 90% of surveyed Medicare Advantage enrollees said supplemental benefits were important to them, while 74% of traditional Medicare beneficiaries said the same.

What's more, socioeconomic factors played a role in the perceived importance of supplemental benefits.

"People with an income of less than $50,000 were more likely to report that supplemental benefits were important than were those earning $100,000 or more. Beneficiaries with functional limitations and Black or Hispanic beneficiaries were more likely to report that supplemental benefits were important than beneficiaries without functional limitations and white beneficiaries," the report noted.

"This pattern is consistent with previous research indicating that supplemental benefits are more valuable for beneficiaries of lower socioeconomic status and those who identify as Black or Hispanic."

Despite Medicare Advantage beneficiaries reporting that they value these benefits, actual use of supplemental benefits varied. For example, two in five Medicare Advantage enrollees reported using dental or vision benefits, and one in 15 reported using hearing benefits.

Other benefits appeared to be more popular, with 46% of Medicare Advantage enrollees reporting using an over-the-counter medication benefit. Those with lower incomes and those who perceived supplemental benefits to be important reported even higher rates of use of an over-the-counter medication benefit.

Most of the Medicare Advantage enrollees included in the study were enrolled in plans that offered dental, vision, hearing and over-the-counter medication benefits, but use of these benefits was not consistent.

"This is the case despite clinical recommendations that people get regular dental exams, such as every six months, an eye exam every one or two years, and a hearing exam every few years. Moreover, most [Medicare Advantage] beneficiaries are enrolled in plans that allow one dental, eye, and hearing exam every year without cost sharing," the report stated.

"This evidence reinforces other data showing that Medicare beneficiaries tend to underutilize their [healthcare] benefits. For example, only about 45 percent of beneficiaries each year use the Annual Wellness Visit benefit, a Medicare benefit with no cost sharing. Clearly, underuse is an area requiring further research."

CMS' Contract Year (CY) 2025 Medicare Advantage and Part D final rule aimed to address this issue. The rule requires Medicare Advantage plans to notify beneficiaries of the supplemental benefits available to them and issue a mid-year notification of unused supplemental benefits that is personalized to each enrollee.

Jill McKeon has covered healthcare cybersecurity and privacy news since 2021.