GAO Digs Into Medicare Advantage Plans' Supplemental Benefits Offerings
The GAO analysts who wrote the new report looked only at Medicare Advantage plans, not at Medicare supplement insurance policies.
Supplemental Benefits
CMS and federal law impose restrictions on the kinds of benefits ordinary Medicare Advantage plans can offer.
For years, plans have been able to offer some types of extra benefits, such as vision care, dental care and hearing care benefits.
In 2019, during the administration of former President Donald Trump, CMS began to let plans offer extra benefits that could reduce avoidable health care use. In 2020, the agency let plans add benefits that could improve or maintain the health or function of chronically ill enrollees.
GAO’s New Report
The Bipartisan Budget Act of 2018 includes a provision that calls for the GAO to review the plans’ supplemental benefits.
When conducting the review, the GAO focused on ordinary Medicare Advantage plans in the 50 states and the District of Columbia that serve individual enrollees and offer prescription benefits.
The team excluded special kinds of “Medicare Part C plans,” such as employer-sponsored plans, Medicare-Medicaid plans and Program of All-Inclusive Care for the Elderly plans.
Here’s a look at the percentage of enrollees in the plans reviewed that offered certain types of benefits to at least some enrollees in April 2022:
Routine eye exams: 99.1%
Fitness programs: 97.3%
Oral exams: 93.0%
Routine hearing exams: 90.9%
Meals for a limited time: 68.7%
Transportation for medical needs: 41.1%
In-home care services, such as help with eating, dressing and housework: 16.3%
Food and produce: 12.5%
Meals beyond a limited basis: 6.5%
Adult day health services: 0.7%
Data Challenges
Plans told the GAO that they have problems with reporting on some benefits to CMS because there are no procedure codes for some of the newer benefits, such as food purchase subsidies.
Another challenge is that CMS believes that plans are supposed to report on instances of enrollees using the new supplemental benefits, but many plans believe the usual CMS patient encounter reporting rules do not apply to the supplemental benefits, Rosenberg writes.
The GAO is recommending that CMS clarify the supplemental benefits use reporting rules and tell plans how to proceed when a benefit lacks a procedure code.
(Image: Thinkstock)
