2024 AEP Insight Series: Report 4 📊

Supplemental and Enhanced Benefits Medicare Advantage Plans: Trends and Transformations of the Non-SNP Market

October 19, 2023 Market Research

Benefits are one of the key features of the Medicare Advantage (MA) plan that differentiates it from traditional Medicare. It is important for beneficiaries to carefully review the benefits offered by different Medicare Advantage plans to ensure they are selecting the plan that best meets their healthcare needs with premium quality of care and access to a wide range of services.

In this article, we take a detailed look at the importance of Supplemental and Enhanced benefits by providing insights into how these benefits have evolved and continue to shape the ever-changing landscape of healthcare. Our exploration delves deep into the diverse spectrum of these benefits, scrutinizing their trends in the domains of HMO and PPO plans, with a focus exclusively on Non-Special Needs Plan type (Non-SNP) by utilizing the Landscape, Crosswalk, and PBP data released by CMS.

Supplemental benefits:

99% of all Non-SNP plans offer Eye Exams (4,393), Enhanced Benefits (4,388), and Emergency (4,366) as Supplemental benefits. A significant proportion of total plans, typically ranging from 85% to 97%, include many other benefits, such as Hearing Exams, Dental Preventive, Eye Wear, Hearing Aids, Outpatient Blood Services, Physical Exams, Comprehensive Dental Coverage, Inpatient Hospital Care, and Over-the-Counter (OTC) benefits. Meal benefits, on the other hand, are included in 3,153 (71%) total plans. However, the remaining Supplemental benefits are less commonly offered, with each offered in less than 40% of all Non-SNP plans.

Over the years, there has been an increase in the number of total plans offering various Supplemental benefits. Nevertheless, a notable change took place in the subsequent year, where certain benefits declined in availability. The most substantial decline was in plans offering Transport by 15% year-on-year (YoY), followed by Acupuncture (-8% YoY). Conversely, other benefits, despite an increase, showed only a marginal 1% YoY growth. This points to 2024 shaping up to be a conservative year for Payors, where they seem to be taking a more cautious approach to their services.

According to the percentage of inclusion, nearly all the new plans incorporate Eye Exams, Emergency coverage, Eye Wear, Enhanced Benefits, Hearing Exams, Dental Preventive, Hearing Aids, Physical Exams, and Outpatient Blood services, each exceeding 95%.

However, The coverage trend over the years is quite interesting. In 2022, the availability of new plans saw a decline in 17 Supplemental benefits, but things looked up in 2023, as these benefits made a comeback with increased offerings. On the flip side, 2024 showed a downward trend in all the Supplemental benefits, notably Enhanced benefits dropped by 181 plans and Dental Comprehensive by 176 plans.

Also Read – Research Report: Medicare Advantage in 2024 – A Look at Premiums, Deductibles, and MOOP Offerings

HMO Plans

Apart from Meals (71%), Transport (49%), Podiatry (39%), Acupuncture (35%), Chiropractor (28%), Psychiatry (12%), Cardiac benefits (1%), and SNF (0.06%), all other Supplemental benefits are available in over 85% of the HMO plans in 2024.

The trend in the number of HMO Plans offering various Supplemental benefits had previously seen a gradual increase, but in 2024, there was a notable decrease for the first time. The most significant YoY decrease was observed in Transport (-18% YoY), Acupuncture (-12%), and Podiatry (-10%), while the HMO plans providing Cardiac benefits remained unchanged. Interestingly, SNF benefits, previously absent in HMO plans, were introduced again in 2024, with two plans offering this benefit.

New HMO plans exhibit a similar pattern when it comes to offering various Supplemental benefits at the national level. In other words, New HMO Plans offering Supplemental benefits experienced a notable decline in 2022, saw a recovery in 2023, but then experienced another significant decrease in 2024. Noteworthily, except for Psychiatry benefits, all other benefits experienced a more pronounced decline in 2024 compared to the increase observed in 2023.

PPO Plans

Unlike HMOs, PPOs have shown an increase in the availability of Supplemental benefits over the years, except for Transport, which showed a decline of 7% YoY. However, the growth in PPO plans remained relatively modest, recorded at 9% or lower for almost all Supplemental benefits in 2024.

In contrast, the coverage of Supplemental benefits in new PPO plans took a different turn in 2024, marking the first decrease. The most significant drop was observed in Acupuncture at a substantial 45% drop YoY, while the remaining benefits showed a decline ranging from 12% to 27% YoY.

Enhanced benefits:

Among the 22 Enhanced benefits offered across various plans, Fitness is the most commonly offered benefit since 2017, constituting 97% of Non-SNP plans next year but less than 98% in 2023, while Adult day health service benefit was the least, at 0.05. Notably, only 41% of Enhanced benefits experienced YoY growth in coverage, while Enhanced Disease Management and Remote Access Technology benefits remained the same as the previous year.

The top three Enhanced benefits are Fitness, Remote Access Technologies, and Health Education in terms of coverage in both total and new plans. Interestingly, apart from Health Education in total plans, these benefits decreased in coverage in 2024, showcasing conservative growth of the MA market even in the benefit trend.

The availability of Bathroom Safety Devices benefit saw the biggest jump in total plans from 497 in 2023 to 1026 in 2024, marking second place according to YoY growth, while the first rank goes to Wigs for Hair Loss Related to Chemotherapy benefits with a 210% YoY increase, a remarkable rise from 256 to 793 total plans. Medical Nutrition Therapy (MNT) benefits have increased in coverage from 484 to 564 total plans.

In contrast, the inclusion of several benefits in plans, including In-Home Support Services, witnessed a significant 42% YoY reduction in total plans despite experiencing growth in 2023, and a similar pattern was observed in Re-admission and Additional Sessions of Smoking and Tobacco Cessation Counseling (-2%) benefits.

In new plans, Fitness benefit has significantly decreased in coverage from 644 to 469 plans and Remote Access Technologies have 99 plans less available than in 2023. There was a continued decline in new plan offerings for Counseling services (-87% YoY), while Alternative Therapies (-64% YoY) demonstrated a drop in 2024, after noticing a rise in 2023. Wigs for Hair Loss Related to Chemotherapy and MNT have noticed an increase in the inclusion of new plans in 2024 reaching 153 and 102, respectively.

HMO Plans

The trend observed at the national level aligns with the changes in HMO plans. The highest number of plans offering Fitness (2,379 total & 203 new plans), Remote Access Technologies (1,839 total & 154 new plans), and Health Education (1,022 total & 108 new plans) representing the top positions.

Notably, there has been a significant increase in the proportion of plans providing Bathroom Safety Devices benefits, rising from 14% to 26% in total plans and from 21% to 25% in new plans. Similarly, Wigs for Hair Loss Related to Chemotherapy benefits increased in both total plans (from 7% to 15%) and new plans (from 12% to 27%).

Thirteen benefits in the total plan category and 16 benefits in the new plan category have experienced a decrease in the availability of different Enhanced benefits. In coverage of total plans, Nutritional benefits saw substantial YoY growth, increasing from 65% to 68% in 2022, but this growth moderated to 5% from 2022 to 2023, and it declined to 4% YoY in 2024. Conversely, plans offering few benefits like Home-Based Palliative Care, In-Home Safety Assessment, and MNT had reduced in 2023 but noticed a slight increase in 2024.

New HMO plans that offer Fitness, PERS, Nutritional/Dietary benefits, Health Education, and Remote Access Technologies are declining by an average of 36% YoY. The highest decline in new plan availability was seen in the Enhanced Disease Management benefit, down 84% YoY, while the In-Home Safety Assessment had the highest YoY growth. However, Counseling Services and Adult Day Health Services have no new plans in the Non-SNP HMO category.

PPO Plans

Differing from national and HMO trends, PPOs saw a rise in plan coverage for Fitness, Remote Access Technologies, and Health Education at a slower pace in 2024, accounting for 99.3%, 74.2%, and 36%, respectively.

Adult Day Health Services benefit has not been offered in any plans since 2023, left out again in 2024. The Wigs for Hair Loss Related to Chemotherapy benefit gained coverage in 345 additional plans, bringing the total to 411 in 2024. Similarly, the Bathroom Safety Devices benefit was included in 251 more plans, reaching a total of 399 plans, making these two benefits the most prominently added among Enhanced benefits.

In PPO plans, six benefits experienced a decline in total plan inclusion, notably In-Home Support Services, dropping from 147 to 68 plans equates to a 54% reduction YoY, followed by Re-admission Prevention (-36%), Counseling Services (-27%), Therapeutic Massage (-20%), PERS (-13%), and Post-discharge In-Home Medication Reconciliation (-7%).

The coverage of the new PPO plans will experience a decrease in Fitness by 63 and Remote Access Technologies by 24, marking the most significant drop among new plans compared to other benefits. As noticed at the national level, Wigs for Hair Loss Related to Chemotherapy benefits also saw the highest hike in coverage of PPOs from 27 to 96.

However, among Enhanced benefits in new plans, 55% experienced a reduction in availability, with Post-discharge In-Home Medication Reconciliation benefits showing the highest YoY decline at 75% YoY.

Conclusion:

In summary, our analysis of the benefit trends for Non-SNP Medicare Advantage plans reveals that many Supplemental benefits have remained consistent in total plans; a more cautious approach is evident in new plan offerings for 2024, with a significant decline in inclusion. On the other hand, Enhanced benefits display a mixed pattern, with some benefits experiencing remarkable growth and others undergoing declines, especially in new plans.

These trends vary between HMO and PPO plans, reflecting the evolving nature of healthcare offerings and the diverse choices available to beneficiaries in the market. These fluctuations in benefit availability over the years reflect the dynamic nature and how payors may adapt their offerings in response to changing healthcare needs and economic considerations.