In 2022, 48% of Medicare beneficiaries were enrolled in Medicare Advantage plans instead of original Medicare. This number is projected to grow in 2023. Most Medicare Advantage plans offer additional supplemental benefits, such as money toward dental or vision care, which isn’t covered by original Medicare. About 1 in 4 people say extra benefits pushed them to choose Medicare Advantage, according to a survey by the Commonwealth Fund.
Despite the marketing value of these supplemental benefits, the utilization remains very low. Since CMS has relaxed the requirement that Advantage plans must provide the same services for all enrollees, they now have highly variable benefit designs and eligibility criteria. Some plans are combining multiple benefits into packages. There are differences in prior auth requirements. There is also a lack of consistency. A benefit may be offered in one year and withdrawn in the next year.
This has led to a lot of confusion among beneficiaries and their care teams, with an increasing number of members that are upset with their choices. Beneficiaries are facing difficulty understanding the terms, conditions, and restrictions of the benefits, which can make it hard for them to know when and how to use them.
It is not easy for them to understand the process for requesting or obtaining these benefits, and they are often unaware of the specific providers or facilities that offer the services.
At Sprite Health, we understand the importance of supplemental benefits to address social risk factors and complex medical needs. Our whole-person care platform provides the technology that helps Medicare Advantage plans to improve the utilization of supplemental benefits:
- Education and Outreach: Our health navigation tools provide beneficiaries with clear and accurate information about the supplemental benefits that are available through their Medicare Advantage plan. This includes information about how to access the benefits, what services are covered, and any restrictions or limitations on the coverage.
- Simplifying the process: The system streamlines the process for accessing and using supplemental benefits to make it as easy as possible for beneficiaries. This includes reducing the number of steps required to request a benefit or providing clear instructions on how to access the services.
- Partnering with providers: Our integrated care management module enables health plans to work with healthcare providers, community organizations, and other stakeholders to increase awareness of the supplemental benefits among beneficiaries and to provide education and support to help them access the services.
- Targeting specific populations: The data platform and analytics enable tailored education and outreach efforts to specific populations, such as low-income beneficiaries or those with specific health conditions, who may be more likely to benefit from certain supplemental benefits.
- Monitoring and evaluation: The platform collects data on the utilization of supplemental benefits and uses this information to identify areas where additional education and outreach efforts may be needed.
- Staying updated: The systems keep beneficiaries informed of any changes to the supplemental benefits offered by the plan and make sure they are aware of the changes and how they can use the new benefits.
If you are a health plan offering supplemental benefits, connect with us to learn how we can help you improve the utilization of these benefits and provide you insights into which one of these benefits is driving lower medical costs.