A recent study reveals that Medicare Advantage plans, despite costing more, do not provide significantly more dental, vision, and hearing benefits compared to traditional Medicare.
The research highlights similar out-of-pocket expenses for both types of plans and questions the additional spending by Medicare Advantage, suggesting that the extra costs may not adequately benefit enrollees.
Understanding Medicare Advantage’s True Benefits
Medicare Advantage plans, the privatized alternative to traditional Medicare, often promote additional benefits such as dental, vision, and hearing coverage — services not included in traditional Medicare. However, a recent analysis found that beneficiaries enrolled in Medicare Advantage plans do not typically receive more of these services than those with traditional Medicare. The study also revealed that out-of-pocket costs for most supplemental services were similar between the two groups. This research, conducted by a team from Mass General Brigham, was published on January 14 in JAMA Network Open.
Financial Implications of Medicare Advantage
“Medicare Advantage plans receive more money per beneficiary than traditional Medicare plans, but our findings add to the evidence that this increased cost is not justified,” said Dr. Christopher L. Cai, the study’s lead author. Dr. Cai conducted the research during his residency in the Department of Internal Medicine at Brigham and Women’s Hospital, a founding institution of Mass General Brigham.
A Closer Look at Medicare Advantage Coverage
To conduct the study, Cai and his colleagues analyzed data from two national surveys — the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey — covering the years 2017 to 2021. The research examined information from a total of 76,557 Medicare beneficiaries.
Only 54.2% of Medicare Advantage beneficiaries were aware of having Medicare Advantage dental coverage while just 54.3% were aware of having vision coverage. Medicare Advantage enrollees were no more likely to receive eye examinations, hearing aids, or eyeglasses than traditional Medicare enrollees.
Economic Impact and Perceived Value
Out-of-pocket expenses for supplemental benefits were similar or modestly lower for Medicare Advantage. Medicare Advantage and traditional Medicare enrollees paid $205.86 and $226.12, respectively, for eyeglasses (9.0% less for Medicare Advantage); $226.82 and $249.98, respectively for dental visits (9.3% less for Medicare Advantage); and no differences for optometry visits or durable medical equipment (a proxy for hearing aids), after adjusting for demographics.
The Real Cost of Medicare Advantage
Nationwide, Medicare Advantage plans’ annual spending on vision, dental services, and durable medical equipment totaled $3.9 billion, while enrollees spent $9.2 billion out-of-pocket for these services and other private insurers covered $2.8 billion. In contrast, Medicare Advantage plans received $37.2 billion dollars annually more than taxpayers would have spent if beneficiaries had enrolled in traditional Medicare, a cost that is partially intended to fund supplemental benefit use.
Senior Author’s Perspective on Medicare Advantage
“Supplemental benefits are a major draw to Medicare Advantage, but our findings show that people enrolled in Medicare Advantage have no better access to extra services than people in traditional Medicare, and that much of the cost comes out of their own pockets,” said senior author Lisa Simon, MD, DMD, assistant professor in the Division of General and Internal Medicine at Brigham and Women’s Hospital. “Older adults and people with disabilities deserve better from Medicare.”
Reference: “Use and Costs of Supplemental Benefits in Medicare Advantage, 2017-2021” by Christopher L. Cai, Sonia Iyengar, Steffie Woolhandler, David U. Himmelstein, Kavya Kannan and Lisa Simon, 14 January 2025, JAMA Network Open.
DOI: 10.1001/jamanetworkopen.2024.54699
In addition to Cai and Simon, authors include Sonia Iyengar, Steffie Woolhandler, David U. Himmelstein, Kavya Kannan.
Cai reported receiving personal fees from the California Health Care Foundation and Alosa Health outside the submitted work. Simon reported receiving personal fees from the American College of Dentists, American College of Legal Medicine, American Dental Association, American Dental Therapy Association, and California Dental Association outside the submitted work. Additional disclosures can be found in the paper.
This study was supported in part by the Brigham and Women’s Hospital Faculty Career Development Grant.
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4 Comments
Medicare advantage is like loaded mutual funds of 30 years ago – more expensive, much worse, and utterly bogus. Unlike loaded mutual funds which just bilked their investors, medicare advantage plans bilks all taxpayers.
Medicare Advantage, in my experience, very strongly advertises Dental, vision, and hearing benefits, so there is no excuse for people who have that coverage not to know about it- they either cannot read, have other problems, or are the same type as those who vote for a failed, felonious ex-president again- ignorant. Your numbers make little sense when comparing dental checkups and cleanings 2X a year- Advantage customer pays 0 % while straight Medicare customer pays 100% without any other insurance coverage. I’ll stick with Advantage!
First of all, I have not read the cited study, so I can not tell from this article, for instance, why Medicare beneficiaries “were not aware” of the enhanced dental, vision and hearing benefits. R. Mand makes a good point on this. Without knowing this, the conclusion by CAI that is cited seems flawed.
Original Medicare does not cover care like dental exams or cleaning; vision exams or eyewear; hearing aids etc. These are considered “maintenance expenses” by CMS (within Medicare Advantage these extras are enhanced benefits) and are not covered. Disease or injury to eyes, ears, or mouth are covered by the medical coverage within Original Medicare or Medicare Advantage. Therefore there can be no apples-to-apples comparison of costs or availability in this particular example. From the rest of the article, it appears there are other such instances of the authors trying to compare apples-to-oranges.
The enhanced benefits are permitted by Medicare legislation and paid for through the difference between the carriers’ bids for MA plans each year, and the money that CMS is permitted to pay the carriers’ for their plans. If Congress wants to pay less, then I would think they would need to pass legislation to lower the outlay, which would have the effect of taking benefits away from Medicare beneficiaries. Those beneficiaries are a very strong special interest group that votes.
For 2025 plans, CMS, provided a small percentage increase in funding for MA, which however, is still less than medical cost inflation. So, to the carrier, this seems like a loss of funding. As a result, extra benefits on most plans are decreasing somewhat and the costs (generally either copays or coinsurance percentages) are increasing a bit.
I don’t understand the claim of “higher costs” for ‘Advantage’ plans. I pay the same for my ‘Advantage’ plan as I would for the original medicare. If I don’t take advantage of all the available benefits, that is on me.