Knowing how to take advantage of all available Medicare benefits isn’t always straightforward, as a recent study of more than 76,000 Medicare enrollees shows.
Research from Mass General Brigham, a nonprofit health care system, concluded that people on Medicare Advantage plans aren’t using the coverage they’re entitled to. The research, based on data from 2017 to 2021, was published in a scientific journal of the American Medical Association.
Medicare enrollees can opt to get benefits in one of two ways — straight from the government (Original Medicare, aka traditional Medicare) or through a private insurance company that contracts with the government (Medicare Advantage plans).
Original Medicare generally doesn’t cover expenses such as dental, vision and hearing care, as we detail in “Retirees, Beware: Medicare Will Not Cover These 11 Medical Costs.”
Medicare Advantage plans are required to cover everything that Original Medicare does; however, they can — and often do — provide additional benefits that Original Medicare doesn’t.
Dr. Christopher L. Cai, lead author of the Mass General Brigham study, says, “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.”
Why?
Because people on Medicare Advantage plans aren’t cashing in on the coverage they’re paying for. Most don’t even know what supplemental benefits are available to them through their Medicare Advantage plans.
For example, researchers found that only 54.2% of those on Medicare Advantage plans were aware of having dental coverage, and only 54.3% were aware of having vision coverage.
Medicare Advantage enrollees also weren’t any more likely to use their plans to receive eye exams, hearing aids or eyeglasses than people with Original Medicare.
People on Medicare Advantage plans also had similar out-of-pocket expenses, paying about 9% less for eyeglasses, with an average of $205.86 out of pocket, while people with Original Medicare paid an average of $226.12.
On average, those on Medicare Advantage plans paid $226.82 for dental visits, and traditional enrollees paid $249.98.
Those slightly lower out-of-pocket costs don’t necessarily translate to better access to care.
For those with vision problems, 78% of Medicare Advantage plan members used corrective eyewear, while 76% of people with Original Medicare did the same. Among those with severe hearing loss, 28% of Medicare Advantage plan members used hearing aids, compared to 29% among Original Medicare participants.
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Medicare Advantage plans spend $3.9 billion annually on vision and dental services and medical equipment for enrollees. At the same time, enrollees themselves pay $9.2 billion out of pocket for these services, while other private insurance companies cover $2.8 billion.
Meanwhile, Medicare Advantage plans receive $37.2 billion more per year than what it would have cost taxpayers if those individuals had signed up for Original Medicare — a cost meant to support the use of extra benefits, researchers write.
“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 on Original Medicare, and that much of the cost comes out of their own pockets,” senior author Lisa Simon says.
Lack of awareness may be the biggest barrier, since more than half of enrollees weren’t aware of their extra benefits.
However, the cost sharing may be a factor as well. The study found that, on average, Medicare Advantage covers about one-fourth of the cost of enrollees’ dental, vision and hearing services.
“Older adults and people with disabilities deserve better from Medicare,” Simon says.
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