A new analysis from Wakely Consulting Group, funded by AHIP, finds that adding dental, hearing, and vision benefits to traditional Medicare without adjusting the benchmark for Medicare Advantage (MA) could result in fewer benefit dollars for MA plans to pay for supplemental benefits, including those that address social determinants of health.
Wakely based its report on current 2021 MA benefit offerings, enrollment, rebate levels, Star ratings by contract, and premium levels. The analysis indicates that if Congress adds these benefits to original Medicare without adjusting the MA benchmark, an MA plan would have an average of 48-73 percent fewer rebate dollars available to fund innovative benefits such as transportation, meals, in-home services and supports, and over-the-counter medicines.
The result is $696-$1,056 a year that a senior or person with disabilities would lose in added benefits that close gaps in care, improve health equity, or offset the impact of social factors on people’s health, AHIP noted.
The MA benchmark is a base rate against which a health insurance provider submits an MA plan bid to the Centers for Medicare & Medicaid Services. The plan bid proposes the coverage and benefits for, and payments to, the plan for the benefit year. The benchmark is based on what the equivalent costs would be for the Medicare program if that individual were enrolled in traditional, or fee-for-service, Medicare.
“Americans should be able to rely on a high-quality Medicare program. Medicare Advantage delivers for a growing number of seniors and people with disabilities,” said Matt Eyles, president and CEO of AHIP in the study announcement. “Asking 27 million Americans to pay for new dental, vision, and hearing benefits in lieu of services they affirmatively chose and have come to rely on is unnecessary and unfair.”
A recent study by the Kaiser Family Foundation revealed that nearly half of all Medicare beneficiaries did not have a dental visit in the past year due to lack of insurance. However, 98 percent of people eligible for Medicare currently have access to an MA plan offering dental, vision, and hearing coverage, according to the AHIP announcement. Seniors also can choose to have coverage for dental, vision and hearing through individual dental policies, Medicare Supplement (Medigap) policies with dental, vision and hearing coverage, employer-provided coverage for working seniors, and the Medicaid program in states where adult dental coverage is provided.
In addition to the cost in terms of lost benefits, not adjusting the MA benchmark could impact other factors, according to AHIP. For example, as of February 2021, about 57.5 percent of all MA members (excluding Prescription Drug Plans) were enrolled in plans with a $0 member premium. The Wakely report finds that adding dental, vision, and hearing benefits without MA benchmark adjustment would limit the ability to maintain plans with $0 premium.