Do Medicare Advantage Plans with Supplemental Benefits Result in Better Plan Ratings?

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When it comes to the older adult demographic, there is an association between social service investments—such as income support, nutrition assistance, and housing support—and a decrease in medical care costs and improvements in health.

As noted by the authors of a study published in JAMA Network Open,¹ medical investments have been on the rise as of late; beginning in 2018, Medicare Advantage (MA) plans were allowed to tackle members’ social needs with the help of Special Supplemental Benefits for the Chronically Ill (SSBCIs). In 2019, the Centers for Medicare & Medicaid Services (CMS) grew the definition of primarily health-related benefits (PHRBs), from only including a set of medical services (such as dental services, eyeglasses, and hearing aids) to now allow Medicare Advantage (MA) plans to provide nonmedical services (adult daycare, in-home support services, and caregiver support).

Progress continued to be made in 2020 when Congress decided that MA plans could now address the needs of chronically ill members via the SSBCIs. This reportedly includes food and produce benefits, more generous meals, nonmedical transportation services, structural home modifications, and indoor air quality supports.

This raises the question explored by the authors of the JAMA study: Was the implementation of supplemental benefits in MA plans that targeted members’ nonmedical and social needs at all related to better plan ratings?

Using the MA Consumer Assessments of Healthcare Providers and Systems (MA CAHPS), investigators explored the association between adoption of a PHRB, SSBCI, or both, along with the changes in enrollees’ overall plan ratings. Data were used from the 2017, 2018, 2019, and 2021 MA CAHPS waves, and every January, a sample of approximately 800 enrollees per contract was gathered and surveyed between the March and June timeframe.

Overall, after comparing 388, 356 plan ratings that represented 467 MA contracts and 2558 plans in 2021, the breakdown of respondent was as follows:

• The mean (SD) age was 74.6 (8.7) years, with 57.2% being female
• 74.6% had at least one chronic medical condition
• 8.9% were fully Medicare-Medicaid dual eligible
• 15.6% were entitled to Medicare due to disability
• 45.1% reported fair or poor physical health

Plans that adopted both benefits saw a noteworthy mean increase of 0.22 points (of 10) in plan ratings (95% confidence interval, 0.4-4.0 points), compared to plans that adopted neither.

Investigators also encountered their share of limitations, including the fact this particular study assessed the role of plan-level adoption of a supplemental benefit on plan rating, but they were unable to assess who specifically in the plan chose which plan or used the benefits. Further, 2020 was unable to be included, being that the MA CAHPS survey was not conducted because of the COVID-19 pandemic. Survey data itself is also open to nonresponse bias and subgroup variations in responses; investigators did find that supplemental benefit adoption was not associated with changes in nonresponse or differentially with the treatment and control groups.

The authors concluded that, “…plans that implemented both supplemental benefits saw a small to medium increase in their overall plan rating compared with plans that did not. This evidence suggests that more investments in supplemental benefits were associated with improved plan experiences, which could contribute to improved plan quality ratings.”

Reference

1. Tucher EL, Meyers DJ, Trivedi AN, Gottlieb LM, Thomas KS. New Supplemental Benefits and Plan Ratings Among Medicare Advantage Enrollees. JAMA Netw Open. 2024;7(6):e2415058. doi:10.1001/jamanetworkopen.2024.15058