Demystifying
Medicare Advantage

Supplemental, Enhanced and SSBCI Benefit Trends

April 4, 2022       Whitepaper

Overview

In 2022, the number of plans offering a supplemental Hearing Exams benefit saw a rise in Florida for the fourth year in a row, while New York saw an increase for the first time since 2018. Across states, there exists similar variations, some of which follow national level trends and some that deviate quite significantly.

These variations in the coverage of benefits across geography is the reason this analysis has been carried out. On a national level, a higher number of plans have been offering Enhanced Benefits, however, this is not the case for every state. In California, for example, it is the Eye Exam benefit which has the highest plan coverage. Similarly, Preventive Dental saw a stark uptick in coverage across New York and Texas in 2020 and 2021 but a decline in California in 2020 and a small uptick in 2021.

The Medicare Advantage ecosystem is constantly evolving and is predicted to change more dynamically due to the COVID-19 pandemic. Volatility in the market has increased year on year. Due to a large number of players entering and exiting markets, changes in plan premiums, and alterations to associated cost structures have been more prominent. As our previous whitepaper, Emergence of $0 Premiums* highlights, there was a flurry of $0 Premium plans being introduced since 2019. These plans significantly brought down the plan differentiation factor and increased the effort of beneficiaries as they must evaluate the benefits covered by each plan under consideration. CMS has taken steps to address the comparison challenge by capturing holistic coverage of 11 key benefits on their Medicare Plan Finder (MPF) website default view.

With this paper, we intend to provide our reader with an insight into the benefit coverage provided by plans across the US. These insights are derived from Non-SNP plans listed in the Landscape files released by the Centers for Medicare and Medicaid Services (CMS). It enables the reader to understand table-stakes benefits (more about it in forthcoming section) across various states, trend benefit offerings over the last five years, and compare states on a benefits coverage index. Additional data, analytics, and trend analyses at a more comprehensive, State-County level view, are available on the HealthWorksAI platform. For access to the platform & additional data, please contact us at info@healthworksai.com.

Benefit Structure

Benefits are provided by both Original Medicare as well as Medicare Advantage (MA) Plans, with the latter traditionally providing a more comprehensive offering. Benefits are the differentiating factor upon which a beneficiary can evaluate and compare the multiple plans available in their market. Once the minimum threshold benefits are covered, most plans then attempt to attract beneficiaries to their product by offering additional benefits, while also keeping the cost structure competitive.

To begin with, let us look at the overall benefit categories in the above flowchart. Part-A* and Part-B** offer 5 broad mandatory benefits under Original Medicare. Part-A cover services such as Inpatient Hospital care, Skilled Nursing Facility (SNF) care, Home Health care, Hospice care and Nursing Home care. Part-B cover services such as Home Health Services, Provider services, Ambulance services, Preventive services, and Durable Medical Equipment (DME), among others.

Part-C pertains only to Medicare Advantage plans which offer benefits over and above Original Medicare. Part-C benefits, also known as Supplemental Benefits, can be divided into 2 more categories, SSBCI and Enhanced, each comprising additional coverage for vulnerable beneficiaries.

To learn more about Part A benefits click here

https://www.medicare.gov/what-medicare-covers/what-part-a-covers

To learn more about Part B benefits click here

https://www.medicare.gov/what-medicare-covers/what-part-b-covers

Table Stakes Benefits

Certain benefits have become part of the basic plan feature itself as they are offered by most or all the plans in a market. Beneficiaries tend to regard such benefits as an inherent offering from plans before comparing them on other features. We have termed these benefits as “Table Stakes”, implying their coverage as the minimum criteria for a plan to stay relevant in the market. An interesting finding, as seen below, is that many benefits fall into the Table Stakes category across the country, while others fluctuate between markets.

The top right corner of the scatter plot below, known as a 2X2 matrix, indicates the set of benefits which can be regarded as Table-Stakes in each state. At a National level, we can see that Enhanced Benefit is the highest grosser of enrollments, with over 99% plans providing coverage. The Enhanced Benefit category itself is comprised of 22 sub-benefits. To better assess this large category, we have provided an additional filter dropdown to understand their coverage vis-a-vis enrollment standing.

It is important to note that the number of enrollees under each benefit indicates the number of beneficiaries who have opted for a plan with said benefit. It does not imply a correlation between selected benefit and respective enrollments. Median lines on x and y axis helps to segregate benefits with higher coverage and enrollments from the rest.

Medicare Plan Finder (MPF) Listed Benefits Index

The Medicare Plan Finder (MPF) website from CMS showcases the coverage of 11 benefits at the top level, giving beneficiaries the means to quickly compare plans. With MPF considered a trusted resource for those who are Medicare eligible, this section focuses on those benefits using a single Index to compare their presence across states.

The MPF Listed Benefits Index is a metric calculated using Min-Max normalization, enumerating the 11 benefits listed on the Medicare Plan Finder (MPF) website default page.

To create the index, the state with minimum coverage of the 11 benefits is normalized to 0, and the state with maximum coverage is normalized to 1. Each remaining state is then affixed with a normalized value between 0 and 1, depending on the benefits offered. For example, in the current view, Wyoming has the most plans with minimum benefits coverage while Michigan has the maximum coverage. Hence, they are represented with Index 0 and 1, respectively. All other states are then indexed between, or equal, to those states. An Index value of 0 does not imply a State with no benefits coverages, rather that it provides minimum coverage.

At an individual benefit level, we can see that there is a stark variation across states with Enhanced Benefits being sparsely covered and Supplemental benefits having a relatively higher coverage. Among the biggest markets, Florida provides much better benefits coverage, in relation to the 11 on MPF, as compared to California and Texas. Similarly, this data can be mapped on a county level to track regional benefit offerings and preferences of the eligible population.

Benefit Coverage by Plan Type

At a National level, HMO had a wider coverage as compared to PPO for both Supplementary and Enhanced benefits in 2022, However, Local PPO has seen much growth since 2020. There is a high variation in terms of benefit coverage by different plan types across the states, which signify the customized offering of benefits. There is also a huge gap in coverage of specific benefits, such as Transportation, with the percentage of HMO plans offering it being higher than PPO plans. In Florida, a Meal benefit has been covered by more HMO than Local PPO plans in 2022, but in New York the percentage of Local PPO plans offering the same benefit is higher.

Supplemental Benefits for the Chronically Ill (SSBCI) was introduced in 2020 with relatively sparse coverage. In 2022, Food Produce is the highest offered benefit in the SSBCI category with over 12% of Local HMO plans offering it at a National level, and 7% Local PPO plans offering the same. Therefore, we find quite a variation in the coverage of SSBCI benefits as well, which is further amplified at the state level.

YoY Benefit Coverage Trend

The 20 supplemental benefits have had varied coverage among plans over the last 5 years. At a national level, we see that benefits such as Enhanced Benefit, Eye Exam and Emergency have consistently maintained the top 3 positions since 2017. These benefits have also been availed by maximum of the enrolled population in 2022, further proving their importance. Moreover, plans covering benefits such as OTC, Meal, Transportation, Hearing Aids and Comprehensive Dental have seen the the largest growth. There exists a variation at State-County level in terms of benefits offered and the beneficiary preference captured by percentage of enrollments availing benefits.

Looking deeper into Enhanced Benefit, at a National level, we see that Fitness has been the most widely offered benefit. In 2022, the second most offered benefit, Remote Access Technologies, is present in 73.2% plans. While the plan has not grown to the level it was present in 2019, the growth seen in 2022 can be attributed to the current Covid-19 pandemic.

Top Plans based on Enrollment

In this section, the top 10 benefits offered at a national level have been selected for both the Supplemental Benefits and Enhanced Benefits sections. Focusing on these benefits only, we can see the variation between states as to the number of Top Plans that provide coverage.

At a National level, a focus on the top plans (highest enrollment based on February data) shows that there has been a clear increase in the number of plans that provide Comprehensive Dental coverage from 2017 to 2022. There are regional variations as well, like in the state of Colorado where most top plans included Comprehensive Dental Coverage in 2017, reduced coverage through 2020 and revived the coverage in 2021. Other benefits, such as Inpatient Hospital, Emergency and Eye Exam, have always been a part of the top plans since 2017.

Across years, Fitness and Remote Access have been present in top plans with little to no presence of other enhanced benefits. However, it can be seen that more top plans have introduced enhanced benefits, particularly Personal Emergency Response Systems (PERS).

Conclusion

As found throughout this study, the coverage of specific benefits across the nation presents layers of both commonality and variability. The constant evolution of the Medicare Advantage marketplace, and external factors like public perception for specific conditions, will ensure the dichotomy continues. Looking at 2022 and beyond, it is presumed that new benefits will progress as Table Stakes while others will see heavy year-over-year variation. A result of payers seeking new & innovative ways to differentiate their offerings against competition. Product Managers, responsible for the design of these complex benefit packages, must continue to analyze regional factors to develop attractive, differentiated plans while still maintaining relevancy. Market level variables such as beneficiary demographics, competitive landscape, consumer preference, and required table stakes benefits not only shape the design of the plans but ultimately serve as a key indicator in their ability to acquire market share.

HealthWorkAI, an advanced analytics company specializing in the Medicare Advantage marketplace, provides access to these variables and supports complex decision-making processes for Health Plans. Leveraging vast public and private data sets, layered with proprietary methodology & machine learning, HealthWorksAI has developed a process to derive the correlation between specific benefits and enrollment outcomes. Furthermore, the price elasticity of benefits can be identified, providing Product Managers guiderails for the allocated cost structure. For more information on how these methods can support benefit design in any market, contact our team at info@healthworksai.com.

Considerations

  1. This study was carried out using Landscape data and the February Enrollment files from the last 5 years released by CMS.
  2. Plans with no enrollment or enrollments less than 10 total have been excluded from the study. Also this study focuses only on Non-SNP plans.
  3. Alaska does not feature in this study as it is not included in the Landscape file released by CMS.
  4. A zero value in the MPF Index does not indicate that the value present for the state is zero. Rather it shows us that the state has the lowest value of % Benefit.
  5. The number of enrollees shown under each benefit within this analysis indicates the number of Medicare eligibles who have opted for a plan with said benefit and does not imply a correlation between selected benefit and monthly enrollments.
  6. Any blanks values shown in the various graphs or tables indicate that there is no data available based on the filters selected.