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Supplemental Benefits Must Return to Value


After years of “up-and-to-the-right” growth, Medicare Advantage plans are encountering headwinds, with declining reimbursement rates, slower membership increases, rising competition, and increasing utilization combining to put a damper on plans’ recent earnings. Nearly every publicly-traded plan expects their medical-loss ratio (MLR) to increase in 2024.In response, a number of payers have stated that supplemental benefits may be on the chopping block. These benefits include a wide variety of medical and non-medical programs — the most common being dental, hearing, and vision insurance. But beyond these core services that have underpinned MA’s value proposition to consumers, plans are reconsidering their portfolios and repositioning for MA’s next leg of growth.

At the same time, regulators are growing increasingly cognizant of plans’ investment in benefits that provide no measurable value to beneficiaries. Over the past five years, per-person payments from the Centers for Medicare and Medicaid Services (CMS) to MA plans for these benefits have more than doubled. New rules authorized for the 2023 plan year require MA plans to report usage on certain categories of benefits, and the industry expectation is that efforts to enhance transparency in this area will only increase.

All this means that supplemental benefits must evolve: they will need to show real, tangible value, both to payers operating in a cost-constrained environment, and to the members they’re meant to serve.

Expect plans to increasingly look to innovative solutions that can engage members earlier and for longer than episodic, in-person appointments. Here’s what else will define the new era for supplemental benefits.

 – Benefits must be designed for members, not checkboxes

The most important factor in the evolution of supplemental benefits, one that is already underway, will be an increased focus on offering solutions that are specifically designed for older adults and their unique needs.

Take the gym. Offering gym memberships is one of the most common supplemental benefits in MA today, yet adults 65 and over are the least likely demographic to hold a gym membership — fewer than 1 in 10 hold a membership.

It’s not that older adults don’t wish to exercise — far from it. Rather, it’s that exercise often must look different for this demographic, and brick-and-mortar gyms can sometimes struggle to meet the need. Expect to see an increasing number of virtual options that can tailor programs to members’ specific circumstances, including those who may have multiple chronic conditions, are frail, or have limited mobility.

 – Benefits must engage beyond annual enrollment

One of the most common knocks against supplemental benefits has been that they exist purely for marketing purposes, designed to make a splash and grab attention during annual enrollment with little usage beyond it. But as regulators take a greater interest in this space, and plans become increasingly focused on MLR reduction, supplemental benefits will be assessed according to two additional criteria: whether they can engage members, and whether they can reduce costs. Tech-enabled solutions can play a key role in filling gaps between members’ doctor’s visits by providing around-the-clock access to services along with support through education and community resources, to ensure that members receive value from their benefits all year long.

 – Benefits must be equitable

Finally, one of the crucial developments in Medicare Advantage is the coming launch of the Health Equity Index, which will assess plan performance as it relates to addressing the social determinants of health and meeting the needs of historically underserved populations, starting with those who are low-income, dually-eligible for Medicaid and Medicare, or who qualify for Medicare because of a disability. Plans that score highly will potentially earn bonus payouts. The welcome focus on ensuring equitable outcomes means that plans will seek out benefit partners that offer up personalized solutions to members, recognizing that one-size-fits-all solutions have left far too many behind.

The coming changes to supplemental benefits are positive. For members, it means they will have greater access to solutions designed with them in mind and built on solid evidence bases. For plans, it means that supplemental benefits will become more closely aligned with the preventive approach they take in the rest of their businesses. While benefit portfolios may end up slimmer, they could also be more powerful — and more like the health care older adults deserve.

Photo: zimmytws, Getty Images



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