A recent study reveals that Medicare Advantage plans, despite costing more, do not provide significantly more dental, vision, and hearing benefits compared to traditional Medicare.
The research highlights similar out-of-pocket expenses for both types of plans and questions the additional spending by Medicare Advantage, suggesting that the extra costs may not adequately benefit enrollees.
Understanding Medicare Advantage’s True Benefits
Medicare Advantage plans, the privatized alternative to traditional Medicare, often promote additional benefits such as dental, vision, and hearing coverage — services not included in traditional Medicare. However, a recent analysis found that beneficiaries enrolled in Medicare Advantage plans do not typically receive more of these services than those with traditional Medicare. The study also revealed that out-of-pocket costs for most supplemental services were similar between the two groups. This research, conducted by a team from Mass General Brigham, was published on January 14 in JAMA Network Open.
Financial Implications of Medicare Advantage
“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 Dr. Christopher L. Cai, the study’s lead author. Dr. Cai conducted the research during his residency in the Department of Internal Medicine at Brigham and Women’s Hospital, a founding institution of Mass General Brigham.
A Closer Look at Medicare Advantage Coverage
To conduct the study, Cai and his colleagues analyzed data from two national surveys — the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey — covering the years 2017 to 2021. The research examined information from a total of 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.
Economic Impact and Perceived Value
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.
The Real Cost of Medicare Advantage
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.
Senior Author’s Perspective on Medicare Advantage
“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.”
Reference: “Use and Costs of Supplemental Benefits in Medicare Advantage, 2017-2021” by Christopher L. Cai, Sonia Iyengar, Steffie Woolhandler, David U. Himmelstein, Kavya Kannan and Lisa Simon, 14 January 2025, JAMA Network Open.
DOI: 10.1001/jamanetworkopen.2024.54699
In addition to Cai and Simon, authors include Sonia Iyengar, Steffie Woolhandler, David U. Himmelstein, Kavya Kannan.
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.
This study was supported in part by the Brigham and Women’s Hospital Faculty Career Development Grant.
