Adding these benefits to traditional Medicare without adjusting the benchmark for Medicare Advantage could result in an annual loss of more than $1,000 in supplemental benefits, including those that address social determinants of health
WASHINGTON, D.C. – (August 27, 2021) – America’s seniors deserve better health care and services at a better value. If Congress makes the decision to add new health care services to original Medicare, it must be done without harming the 27 million Americans who have Medicare Advantage (MA). A new analysis from Wakely Consulting Group, funded by AHIP, finds that if Congress adds these benefits to original Medicare without adjusting the Medicare Advantage benchmark*, an MA plan would have an average of 48-73% fewer rebate dollars available to fund innovative benefits such as transportation, meals, in-home services and supports, over-the-counter medicines, or other benefits that the more than 41% of Medicare-eligible Americans have come to rely on. That amounts to $696-$1,056 a year that a senior or person with disabilities would lose in added benefits that close gaps in care, improve health equity, or offset the impact of social factors on people’s health.
“Americans should be able to rely on a high-quality Medicare program. Medicare Advantage delivers for a growing number of seniors and people with disabilities,” said Matt Eyles, president and CEO of AHIP. “Asking 27 million Americans to pay for new dental, vision, and hearing benefits in lieu of services they affirmatively chose and have come to rely on is unnecessary and unfair.”
Today, 98% of people eligible for Medicare have access to an MA plan offering dental, vision and hearing coverage. People also can choose to have coverage for dental, vision and hearing through individual dental policies, Medicare Supplement (Medigap) policies with dental, vision and hearing coverage, employer-provided coverage for working seniors, and the Medicaid program in states where adult dental coverage is provided.
In addition to the cost in terms of lost benefits, not adjusting the MA benchmark could impact other factors of value for Americans. For example, as of February 2021, about 57.5% of all MA members (excluding Prescription Drug Plans) were enrolled in plans with a $0 member premium. The Wakely report finds that adding dental, vision, and hearing benefits without MA benchmark adjustment would limit the ability to maintain plans with $0 premium.
Proposals Would Harm 27 Million Enrollees
Proposals to use MA to pay for new benefits for traditional Medicare would be devastating for the 27 million seniors and people with disabilities who are overwhelmingly satisfied with their MA plans. A Coalition for Medicare Choices poll found that:
- 95% of seniors with MA would recommend it to their family and friends.
- 93% of seniors with MA are satisfied with their preventive services – things like screenings, vaccines, and testing to keep them healthy.
- 92% of seniors are satisfied with the drug coverage they have through MA.
MA also covers more racially diverse populations than traditional Medicare, and 57% of enrollees are women. Approximately 40% of MA enrollees make less than $25,000 per year, and around 9 million have an income below 200% of the federal poverty level.
“MA is popular because it delivers better health and great value for seniors and people with disabilities,” Eyles added. “Tens of millions of MA seniors should not pay the price for improving traditional Medicare.”
About AHIP
AHIP is the national association whose members provide health care coverage, services, and solutions to hundreds of millions of Americans every day. We are committed to market-based solutions and public-private partnerships that make health care better and coverage more affordable and accessible for everyone. Visit www.ahip.org to learn how working together, we are Guiding Greater Health.
*Editor’s Note: The MA benchmark is a base rate against which a health insurance provider submits an MA plan bid to the Centers for Medicare & Medicaid Services (CMS). The plan bid proposes the coverage and benefits for, and payments to, the plan for the benefit year. The benchmark is based on what the equivalent costs would be for the Medicare program if that individual were enrolled in traditional, or fee-for-service, Medicare.
*Editor’s Note 8/27/2021: The initial version of this press release included an incorrect figure in the amount of supplemental benefits seniors stand to lose if these proposed changes to Medicare are not benchmarked. That figure has been corrected from $970-$1,056 to $696-$1,056. AHIP regrets the error.