NYC Gazette

Lower-income adults enrolled in Medicare Advantage plans face greater challenges affording dental, vision, and hearing services compared to their higher-income counterparts, despite the coverage these plans offer. This is according to a study published in Health Affairs.

Medicare Advantage provides an alternative to traditional Medicare by offering private insurance options. Supplemental benefits such as dental, vision, and hearing are included in over 90% of these plans, funded largely by rebate dollars from the Centers for Medicare and Medicaid Services (CMS) to private insurers.

Avni Gupta, a health policy researcher affiliated with the Commonwealth Fund, stated that "the high need for dental, vision, and hearing care among Medicare recipients drives the high demand for supplemental benefits." However, she noted that these benefits are costly for Medicare, which allocates nearly $20 billion annually in rebates to insurers.

The trend shows more low-income older adults opting for Medicare Advantage over traditional Medicare. While supplemental benefits attract these enrollees, they do not fully protect against financial burdens. Beneficiaries still encounter significant out-of-pocket expenses and often skip necessary care.

Researchers analyzed data from a 2018-19 survey of Medicare Advantage beneficiaries to assess whether these plans meet enrollee needs. They considered income levels and plan star ratings—a quality measure—in their analysis.

Findings indicate that lower-income beneficiaries experience more cost-related barriers to accessing services than those with higher incomes. Specifically, about 11% reported unmet dental needs due to costs, while 4% faced unmet vision needs and 2% unmet hearing needs.

Higher-quality plans—those with top star ratings—correlated with fewer unmet dental needs overall and particularly among lower-income groups. However, this correlation did not extend to hearing or vision services. The positive impact on dental coverage was not attributed to CMS's higher rebate payments linked to star ratings.

Gupta questioned whether "the higher rebate payments to highly rated Medicare Advantage plans in the form of the quality bonus payments actually improve access to the funded services for beneficiaries."

The researchers suggest CMS should evaluate how well supplemental benefits cover essential services like dental, vision, and hearing care. José A. Pagán from NYU School of Global Public Health emphasized that increased oversight could ensure rebate dollars effectively enhance equitable access: "Good stewardship in rebate payments means that Medicare Advantage beneficiaries should get the highest possible value as a result of financial incentives."

The study involved contributions from Diana Silver at NYU School of Global Public Health; Sherry Glied at NYU’s Robert F. Wagner Graduate School of Public Service; Kenton Johnston at Washington University in St. Louis; and David Meyers at Brown University School of Public Health.