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Witnesses defend supplemental benefits in Medicare Advantage while urging transparency on utilization
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Summary
Plan executives and nonprofit plan leaders said supplemental benefits such as meals, transportation and integrated Part D coverage help beneficiaries, but analysts and lawmakers urged more transparent reporting on how those dollars are used.
Several witnesses told the House subcommittees that supplemental benefits are a core reason many beneficiaries choose Medicare Advantage and that those benefits can reduce utilization and improve outcomes when targeted to high-need patients.
Dawn Maroney, CEO of Alignment Health Plan, described an instance where a data-flagged, high-risk member received a $30 meal delivery that averted a costly hospitalization. “When we sent him a $30 pizza instead of sending him to the hospital, it not only avoided an unnecessary $20,000 hospitalization, it built trust,” Maroney said.
Sachin Jain, president and CEO of SCAN, argued MA’s flexibility to cover integrated services — dental, vision, hearing, transportation and care coordination — helps lower out-of-pocket costs for beneficiaries who cannot afford supplemental Medigap plans. “Medicare Advantage helps fill those gaps,” Jain said, adding that MA often acts as a social-safety-net alternative for lower-income older adults.
Policy tension: Economists and oversight-focused witnesses warned that the extra spending on MA supplemental benefits is paid for in part by higher plan payments and could be inefficient if the dollars are not reaching beneficiaries. Brookings’ Matthew Fiedler said evidence suggests only part of additional MA payments is returned to enrollees as higher benefits; some is retained as profits or marketing.
Lawmakers asked for more utilization data on supplemental benefits. Rep. Terri Sewell and others noted CMS lacks comprehensive, public reporting on how often beneficiaries use supplemental benefits and which types deliver measurable health improvements.
Veterans and dual-eligibles: Rep. Doggett highlighted a concern about MA payments tied to dually eligible veterans receiving care from the VA, saying researchers estimate a potential multibillion-dollar misalignment over time. He and other members described pending legislation intended to allow the VA to recoup costs in some VA-delivered care scenarios.
What witnesses recommended: Increased transparency on supplemental-benefit utilization, better CMS reporting and targeted evaluation of which benefits demonstrably reduce medical spending or improve outcomes. Several witnesses asked Congress to preserve MA’s ability to innovate while tightening oversight to ensure supplemental dollars reach patient care.
