Medicare Advantage Beneficiaries Did Not Receive More Dental, Vision or Hearing Care

Mass General Brigham researchers found that while Medicare Advantage beneficiaries have more supplemental benefits, they did not use more of these services and had similar out-of-pocket costs.

As the privatized form of Medicare, Medicare Advantage plans advertise dental, vision, and hearing benefits not covered by traditional Medicare, but a recent analysis found that Medicare Advantage beneficiaries do not typically receive more of these supplemental services than traditional Medicare beneficiaries. Additionally, out-of-pocket spending was similar for most supplemental services. The research led by a team from Mass General Brigham is published in JAMA Network Open.

“Medicare Advantage plans receive more money per beneficiary than traditional Medicare plans, but our findings add to the evidence that this increased cost is not justified,” said first author Christopher L. Cai, MD, who conducted this work as a resident in the Department of Internal Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham health care system.

For their study, Cai and his colleagues analyzed 2017–2021 data from two continuous surveys, the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey. In total, the investigators assessed information on 76,557 Medicare beneficiaries.

Only 54.2% of Medicare Advantage beneficiaries were aware of having Medicare Advantage dental coverage while just 54.3% were aware of having vision coverage. Medicare Advantage enrollees were no more likely to receive eye examinations, hearing aids, or eyeglasses than traditional Medicare enrollees.

Out-of-pocket expenses for supplemental benefits were similar or modestly lower for Medicare Advantage. Medicare Advantage and traditional Medicare enrollees paid $205.86 and $226.12, respectively, for eyeglasses (9.0% less for Medicare Advantage); $226.82 and $249.98, respectively for dental visits (9.3% less for Medicare Advantage); and no differences for optometry visits or durable medical equipment (a proxy for hearing aids), after adjusting for demographics.

Nationwide, Medicare Advantage plans’ annual spending on vision, dental services, and durable medical equipment totaled $3.9 billion, while enrollees spent $9.2 billion out-of-pocket for these services and other private insurers covered $2.8 billion. In contrast, Medicare Advantage plans received $37.2 billion dollars annually more than taxpayers would have spent if beneficiaries had enrolled in traditional Medicare, a cost that is partially intended to fund supplemental benefit use.

“Supplemental benefits are a major draw to Medicare Advantage, but our findings show that people enrolled in Medicare Advantage have no better access to extra services than people in traditional Medicare, and that much of the cost comes out of their own pockets,” said senior author Lisa Simon, MD, DMD, assistant professor in the Division of General and Internal Medicine at Brigham and Women’s Hospital. “Older adults and people with disabilities deserve better from Medicare.”

Authorship: In addition to Cai and Simon, authors include Sonia Iyengar, Steffie Woolhandler, David U. Himmelstein, Kavya Kannan.

Disclosures: Cai reported receiving personal fees from the California Health Care Foundation and Alosa Health outside the submitted work. Simon reported receiving personal fees from the American College of Dentists, American College of Legal Medicine, American Dental Association, American Dental Therapy Association, and California Dental Association outside the submitted work. Additional disclosures can be found in the paper.

Funding: This study was supported in part by the Brigham and Women’s Hospital Faculty Career Development Grant.

Paper cited: Cai CL et al. “Use and Costs of Supplemental Benefits in Medicare Advantage, 2017-2021” JAMA Network Open  DOI: 10.1001/jamanetworkopen.2024.54699