A new NYU-led study reveals significant financial barriers in dental, vision and hearing services for lower-income Medicare Advantage beneficiaries. Despite the coverage, many still face unmet needs due to high out-of-pocket costs, prompting calls for better oversight and equitable access.
Lower-income adults with Medicare Advantage plans struggle with high out-of-pocket costs for dental, vision and hearing services, despite these plans offering supplemental benefits, a new study led by NYU reveals.
Medicare Advantage plans, which are an alternative to traditional Medicare, provide additional benefits like dental, vision and hearing coverage. These benefits, funded mainly by rebate payments from the Centers for Medicare and Medicaid Services (CMS) to private insurers, attract many older adults, especially those with lower incomes.
“The high need for dental, vision and hearing care among Medicare recipients drives the high demand for supplemental benefits,” Avni Gupta, a health policy researcher who earned her doctorate from NYU School of Global Public Health, said in a news release. “However, these added benefits are expensive for Medicare, which pays nearly $20 billion a year in rebates to Medicare Advantage insurers for supplemental benefits.”
To assess whether these benefits adequately meet the needs of enrollees, the researchers analyzed data from a 2018-19 survey of Medicare Advantage beneficiaries. The study, published in Health Affairs, found significant disparities. Lower-income beneficiaries faced more pronounced financial barriers to accessing dental, vision and hearing services compared to their higher-income counterparts, regardless of the plan’s generosity.
Specifically, nearly 11% of beneficiaries reported unmet dental needs, 4% had unmet vision needs and 2% experienced unmet hearing needs due to cost. Moreover, better-quality Medicare Advantage plans, indicated by higher star ratings, correlated with decreased unmet dental needs. However, this quality rating did not significantly affect access to vision and hearing services.
“This raises questions about 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,” added Gupta.
The study highlights the need for CMS to measure and monitor the coverage, quality and equity of supplemental benefits to ensure that rebate payments translate into real value for beneficiaries.
“As the popularity of Medicare Advantage plans continues to increase, there is a need for more accountability and better oversight on how rebate dollars are being used to improve equitable access to supplemental benefits covering services we all use and need, such as dental, hearing and vision care,” José A. Pagán, professor and chair of the Department of Public Health Policy and Management at NYU School of Global Public Health, said in the news release. “Good stewardship in rebate payments means that Medicare Advantage beneficiaries should get the highest possible value as a result of financial incentives.”
The study emphasizes the crucial need for improved oversight, ensuring that additional funding truly enhances access to essential care for all Medicare Advantage enrollees.