Medicare Advantage Supplemental Benefits: What We've Learned

Health Affairs' Jeff Byers welcomes Senior Editor Kathleen Haddad to the pod to discuss the Forefront series, Supplemental Benefits In Medicare Advantage, and how articles from the series elaborated on issues such as challenges in understanding and accessing benefits, CMS requirements to collect encounter data, the intersection of MA supplemental benefits with Medicaid long-term services and supports, and more.

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Related Articles:

• The People Say
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• Medicare Advantage And Supplemental Long-Term Services And Supports: A Small Step In The Right Direction (Health Affairs Forefront)
• Time To Reexamine The Role Of Supplemental Benefits In Medicare Advantage (Health Affairs Forefront)
• Medicare Advantage Supplemental Benefits: Origins, Evolution, And Issues For Policy Making (Health Affairs Forefront)

Episode Transcript

Jeff Byers (00:08):
Hello and welcome to Health Affairs This Week. I'm
your host, Jeff Beyers. We'rerecording on 06/12/2025. As a
quick note, I know I've talkedabout the Insider Program a lot.
We have a couple of exclusiveevents coming up.
Next week on June 17, we have arisk adjustment event, where J.
Michael McWilliams will discusstrends in risk adjustment and

(00:31):
potential reforms. And on July9, Sarah Rosenbaum will be
moderating a panel wrapping upthe supreme court session and,
what cases were looked at withtheir relation to health care.
And later, have our trend reporton the health care workforce
coming up. You can still checkout our trend report on

(00:53):
artificial intelligence inhealth care as well.
Sign up, and, I'm sure I'll talkabout that more detail when it
actually gets released, theworkforce one. Today on the
program to talk about MedicareAdvantage and its supplemental
benefits, we have KathleenHaddad back on the program.
Kathleen, welcome. Hey, Jeff. SoKathleen, Health Affairs
Forefront is wrapping up a yearlong project.

(01:15):
It was funded by the SCANFoundation. It examines the role
of supplemental benefits andMedicare Advantage. You know,
that's things like in home care,transportation to and from
visits. There's probably a foodelement in there that I'm not
gonna get right. Maybe you canlet us know what some of those

(01:36):
other benefits are.
We did a podcast in September onthese benefits. Now that the
project is wrapping up, whathave we learned?

Kathleen Haddad (01:44):
So, Jeff, we covered so many important topics
in this series, and listenerscan go to our forefront page to
find them. So just to remindpeople what these benefits are,
they are the extra benefits notavailable in traditional
Medicare. Most people arefamiliar with vision, dental,
and hearing supplementalbenefits. Let's call them the

(02:05):
big three. But over the pastfive years, CMS has broadened
the scope to include, like yousaid, food, produce, over the
counter items, and others.
And for special populations,there are benefits such as in
home help with cooking andcleaning, respite care, home
modifications, or help with rentand utilities. We call these
nonmedical benefits.

Jeff Byers (02:26):
Yeah. Okay. Thanks for thanks for backing me up on
that food area. Good to know. II was in the right ballpark.
What makes Medicare Advantagesupplemental benefits an
important policy issue?

Kathleen Haddad (02:39):
So, Jeff, there are two things mainly. These are
benefits that, manybeneficiaries really like, and
they're important to stayinghealthy and functional, yet not
all these benefits are availableto all MA enrollees, and TM
enrollees don't have any ofthem. And then there's the cost,
about 70,000,000,000 annuallythat CMS pays to MA plans to

(03:01):
provide these benefits.

Jeff Byers (03:03):
Yeah. It's interesting. Being comfortable
in the home is something thatpeople tend to like. I know my
other middle aged people outthere feel me. Right?

Kathleen Haddad (03:14):
Well, many of the people who qualify for these
benefits are older, and many ofthem do have some conditions and
and how they how they are ableto stay in their homes or being
able to stay in their homes isreally, really important and
it's cost effective.

Jeff Byers (03:30):
Yeah. I was trying to keep it a little light, but
fair fair. Thanks for keepingthe program honest. One of the
forefront articles in the seriestalks about how beneficiaries
use the benefits and what theylike about them. So what can you
tell us about that?

Kathleen Haddad (03:46):
So there's an organization out there called
the Public Policy Lab, Jeff, andthey, interviewed older adults
who rely on these benefits, andthey catalogued all their
responses into hundreds of databytes that public policy
analysts and advocates can useto understand and communicate
how these benefits impactpeople's daily lives, what they

(04:08):
like and don't like, and what'shelpful and not. The database is
called The People Say, andanyone can use it by going to
the web page and creating anaccount, and it's very
searchable. So, hopefully, wecan put that in our show notes.

Jeff Byers (04:21):
And what do beneficiaries like about these
supplemental benefits?

Kathleen Haddad (04:24):
They really like their benefit debit cards.
An article we had by Joe Juneand Claire Cruz, talked about
how beneficiaries use their flexcards, and they cover some of
their grocery bills or over thecounter items like you and I
would use FSA cards for. And thebeneficiaries really rely on

(04:45):
them and they even to affordtheir monthly grocery bill, and
the cards feel lifesaving tosome of them. But, the cards
also can be very hard to usebecause not all stores or
vendors know what they are oraccept them, And there are
administrative snafus that, someof the beneficiaries described
on, the PeopleSay. And manyplans don't make clear how and

(05:08):
where the cards can be used.
So some of the funds go unused,and plans retain the unused
amount.

Jeff Byers (05:14):
Yeah. So it sounds like these are pretty popular
benefits, but it also soundslike there might be some issues
in accessing these benefits. Socan you outline more of what
some of these issues might be?

Kathleen Haddad (05:25):
So, yeah, good question, Jeff. In our forefront
article in the series, EricRoberts of Penn wrote about the
question of value. So MAbenefits, these benefits,
supplemental benefits are paidfrom rebates that MA plans
realized by bidding for CMSpayment levels that are less
than what CMS would pay forsimilarly sick traditional

(05:47):
Medicare enrollees. So the plansare then required to use the
rebates, these extra payments,to either lower premiums or
offer extra benefits. So manyplans use these benefits to use
the the rebate to offersupplemental benefits and some
as, you know, as marketingenticements to attract
enrollees.
And so at the same time, CMS hasincreasingly relied on MA plans

(06:10):
to provide and coordinateservices for under resourced
beneficiaries and sickerbeneficiaries, including those
who are eligible for bothMedicare and Medicaid, what we
nerds call duals. I'll confessto being a nerd. Another thing
is that that Eric Roberts talkedabout is research that shows

(06:32):
the, amount actually passedthrough to beneficiaries is
relatively low, and it turns outthat it costs the federal
government an additional $2 forevery $1 that MA plans allocate
to reducing costs or expandingbenefits. And this relates to
how something complex about howthe benchmark for the bid is set

(06:53):
set. So I would refer readers tothe Eric Roberts article and the
link in there for more on that.
But he also wrote about limiteddata on the benefits how the
benefits are used and theoutcomes the health outcomes. So
MA plans are required to reportencounter records for all
supplemental services, but afederal audit concluded, that

(07:15):
that Eric cites that MA planshave failed to consistently
report supplemental benefit use.

Jeff Byers (07:21):
We ran an article in the series last month by Amber
Christ and Allison Barkoff aboutproblems coordinating benefits
between Medicare and Medicaid.What can you tell us about this
article?

Kathleen Haddad (07:32):
So, Jeff, that article was about problems
experienced by duals, many whocan enroll in D SNPs, special
needs plans called D SNPs. Somany of these duals qualify
under Medicaid for long termservices and supports, and some
of these services overlap withthe supplemental benefits,
services like in home care, sopeople can live in their homes

(07:55):
and not in nursing homes. Soless than 10% of plans offer
LTSS benefits. This was reportedby Joe June and Claire Cruz of
ATI, a research firm in thisspace, in their article. But
Barkhoff and Christ start off bymaking clear that neither MA
plans nor the Medicare orMedicaid covers the full scope

(08:18):
of LTSS needed by agingAmericans.
There can be chaos when theseenrollees try to access the
services because the plans don'talways coordinate the benefits
very well. So take, as anexample, say someone gets five
hours a week of in home supportby Medicare Advantage plan and

(08:39):
then ten hours by paid byMedicaid, but by different
providers who don't talk to eachother. Or Medicare, Medicaid can
disagree over who pays for thecoverage, which can delay the
needed care. So a bene or abeneficiary may have signed up
for an MA plan just to get aspecific supplemental benefit
that Medicaid already coversgenerously, so that's not

(09:01):
they're not getting the bestvalue they can in their plan
choice. And another article inthe series by Rachel Gershon and
Julie Carter of Justice in Agingand the Medicare Rights Center,
they talk about receiving thesekinds of complaints very
frequently.

Jeff Byers (09:17):
So that article is published today, hot off the
presses. You can check outForefront for that article once
you stop listening to thispodcast while also sharing it
with a friend. What otherproblems with accessing benefits
do Gershon and Carter report?Not to not to give too much away
so they click. But

Kathleen Haddad (09:38):
Yeah. Yeah. Oh oh, there's much more in the
article, but I can go on herefor a while. So, yeah, I'll
start. Anyway, enrollees, reportmisunderstanding the scope of
their benefits or being misledby brokers about the benefits
that are available.
You know, just maybe the brokersor representatives from the
plans, you know, they're notexperts, they may not understand

(10:00):
or communicate the complexitiesinvolved. Gershun and many of
the other authors in this seriescalled on CMS to do a better job
requiring plans to provideaccurate and complete
information for beneficiarieswhen they're choosing a plan.
And the, you know, the issuehere is that Medicare plans,
advantage plans have widelatitude in determining who

(10:23):
among their enrollees iseligible for a benefit. The
Medicare Rights Center reportshearing from Benny's who sign up
for a plan because of a specificbenefit and later learn they're
not eligible for it becausetheir condition doesn't fall on
the plan's list of eligibleconditions. So excuse me.
I use the term Benny's. I usedto analyze Medicare data, and

(10:43):
that's the nerd term, so nodisrespect meant. But, anyway,
the Gershon article also pointsout that Medicare plan finder
doesn't provide detailedinformation on many of the
benefits, like the number oftransportation trips offered or
in home the number of in homevisits allowed. And there are

(11:04):
other problems. Some plansrequire Bene's to opt in or
register for specific benefit.
And if they don't know they haveto do this, then they don't get
the benefit. And then some planshave prior authorization
requirements on the benefits orrestricted networks, and
enrollees often don't know aboutthis, then that can prevent them
from using their benefits.

Jeff Byers (11:26):
So didn't CMS have solutions teed up for some of
these problems in the proposedrule governing these benefits?

Kathleen Haddad (11:32):
Yeah. Jeff, the rule proposed last fall did.
However, many of them were notadopted in the final rule
published this spring. So forexample, CMS did not finalize
its proposal to imposerequirements on how plans use
debit cards to administerbenefits, including guardrails
that would ensure beneficiariesare fully aware of covered

(11:56):
benefits and how to access them.And, CMS did not finalize a
proposal to expand requirementsto define in the provider
directory what community basedservices and in home service
contractors are, and this wouldhave codified a definition and
required them to be included inthe provider directory so

(12:18):
beneficiaries would know whereto go to get the services that
they think that, they signed upfor.
And then CMS didn't finalize aproposal to better regulate
brokers who sell MA plans.

Jeff Byers (12:30):
So, Kathleen, as we wrap up, what are some of the
academic scholars and andthought leaders thinking about
this program moving forward?

Kathleen Haddad (12:40):
They have a number of recommendations. They
propose to that benefits shouldbe standardized to make it
easier for beneficiaries, tomake cross comparisons across
plans, to choose a plan thatprovides the best value for
them. They recommend requiringmore detailed information, on
the benefits in the providernetworks for beneficiaries

(13:01):
during open enrollment, one ofthe items that was not finalized
in the proposed rule. Theyrecommend requiring plans to
report the data more accurately.Researchers can study if the
benefits actually improvehealth, and there are some
issues with this.
It's hard also for plans to doit for IT reasons, but, you

(13:22):
know, it can be done. We sentthe the man to the moon. So
there's work going on on that. Afew authors call for CMS and
congress to reevaluate whetherMA actually detracts from value,
whether traditional Medicareshould take over covering some
of these benefits such as inhome care, especially given

(13:44):
overpayment to MA that makes itpossible to market and provide
these benefits. Eric Roberts andNina Seshamani, a former CMS
director, discussed these issuesin their articles.
But, you know, this is not thedirection congress has taken on
Medicare. So, still whether ornot the benefits are
administered in a way that addsvalue is an important issue that

(14:06):
needs to be addressed, Jeff.

Jeff Byers (14:08):
Yeah. So a lot of information on Health Affairs
Forefront. We'll provide a linkin the show notes to the series
itself. And this project willconclude with a virtual webinar
on July 8. Kathleen, what canyou tell us about that?

Kathleen Haddad (14:23):
So the webinar will feature two authors from
the series, Eric Roberts andClaire Cruz, who I mentioned,
and we'll have the medicaldirector of a community
affiliated MA health plan, thehealth plan of San Mateo, and
he'll talk about how they choosesupplemental benefits to meet
their population's health needsand, the CEO of a vendor of

(14:44):
nonmedical benefits calledHelper Bees who will give us
some insights involved in theissues connecting beneficiaries
to the services they signed upfor. But I wanna mention a
special part of the event willbe a short video that features
older adults who actually tellus about their lived experience
using the benefits, and that wasproduced by, the People Say in

(15:06):
that project.

Jeff Byers (15:07):
Fantastic. And, that event will be free to all. We
will have, availability to signup for that event, sometime next
week. So check our upcomingevents schedule on health
affairs website. We'll also puta link to the schedule in the
show notes, so that will be easyto find the meeting registration

(15:28):
page when it goes live.
But we hope to see you all thereon July 8. And with that,
Kathleen, thanks for joining ustoday on Health Affairs This
Week.

Kathleen Haddad (15:38):
Thank you, Jeff. It was fun.

Jeff Byers (15:40):
And to you, the listener, if you enjoyed this,
it just send it to a friend.Have a great day. Bye.