Medicare Advantage plans have increased in popularity over the last two decades. In 2007, 19% of people eligible for Medicare were enrolled in a Medicare Advantage plan. Today, that number stands at over 50%. The additional benefits and services covered under these plans support enrollees’ whole health, providing additional benefits not offered under other Medicare coverage options.
Federal Laws Make a Difference
Original Medicare made a significant and immediate difference in healthcare coverage levels when it was signed into law in 1965 because it covered a large portion of the population who had become uninsured: those 65 and older, or under 65 with a disability, who were no longer working. While Original Medicare benefits (Parts A and B) have stayed relatively unchanged, the Medicare Prescription Drug Improvement and Modernization Act of 2003 provided the opportunity to offer additional, health-related benefits—known as supplemental benefits—under Medicare Advantage (Part C) plans. Often these benefits include routine dental, vision, and hearing benefits to improve overall health and well-being.
Under the original definition, Medicare Advantage supplemental benefits were required to be medically related and offered uniformly. A whole-health approach, however, addresses physical, behavioral, and social drivers. In 2019, the Centers for Medicare and Medicaid Services (CMS) opened the door to a whole-health approach by expanding the Primarily Health-Related benefits definition and related policies to include non-medical items that can be used to diagnose, treat, and/or prevent an illness or injury. The CHRONIC Care Act of 2020 allowed non-primarily health-related supplemental benefits to be offered to enrollees whose health conditions align with the specific coverage criteria.
Supplemental Benefits that Support Whole Health
This expansion allows for more and different types of offerings — importantly those addressing social drivers of health. Elevance Health’s Medicare Advantage (MA) and Medicare Advantage Dual-Eligible Special Needs (D-SNP) plans exemplify this whole-health approach.
Most plans still offer routine dental, vision, and hearing benefits as well as prescription drug coverage to continue addressing the physical needs of enrollees. Some supplemental benefits help reduce stress. For instance, providing two nutritious meals per day for a set number of days supports members to concentrate on recovery after discharge from the hospital, not worrying about having to buy groceries or cook.
Many members will have access to transportation services to take them to plan-approved locations, removing the pressure of driving or asking others for rides. A lack of transportation can prevent many people from seeking the healthcare services they need. For those who cannot or opt not to travel, telehealth visits for physical and/or mental health conditions are covered through MA plans.
Elevance Health’s Whole-Health Approach Includes Addressing In-Home Needs
Elevance Health-affiliated health plans provide Medicare Advantage and Medicare Advantage D-SNP members with access to a wide range of supplemental benefits. Many people eligible for Medicare have fixed incomes. Addressing their health-related social needs includes helping them live safely at home, whether that’s making sure utility service continues or making the physical environment safer.
Members may choose from flex accounts, providing a monthly allowance to help pay for items such as utility bills. They can also use the allowance to improve physical safety by buying assistive devices like temporary wheelchair ramps.
Members may decide having better access to nutritious food is their top priority. Many plans provide a monthly allowance for the in-person or online purchase of nutritious groceries from local stores. Some plans stipulate this monthly allowance to also be used for over-the-counter and personal care items like vitamins, toothpaste, adult briefs, and blood pressure cuffs.
Use of these plan benefits has been strong, with 75% of Medicare Advantage members and 83% of Medicare Advantage D-SNP members using at least one supplemental benefit. In fact, 24% of Medicare Advantage D-SNP members used four or more benefits while 14% of other Medicare Advantage members used four or more.
Expanding the supports provided through supplemental benefits allows Elevance Health’s affiliated health plans to bring a whole-health approach to their Medicare Advantage and Medicare Advantage D-SNP members. Improving health holistically requires attention to physical, behavioral, and social drivers. Addressing the three in harmony throughout the health journey improves health outcomes.