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New bill expands Medicare Advantage supplemental benefits

New legislation aims to expand Medicare Advantage supplemental benefits. More at - risk and low-income people would be covered.

October 16, 2023

New bill expands Medicare Advantage supplemental benefits

During annual enrollment more and more older Americans and people with disabilities are choosing Medicare Advantage (MA) plans over traditional Medicare coverage. In fact, more than 30 million older adults and people with disabilities have MA plans.

The plans are popular because they offer supplemental benefits such as dental, vision, meal-delivery and gym memberships. By offering those extra benefits, MA plans can do more to support members with chronic illnesses and address the impact of social determinants of health (SDOH) which affect health outcomes. SDOH include health care, economic stability, education, social and community context, and neighborhood and environment.

But those popular supplemental benefits aren’t available to everyone — yet.

New legislation

Currently, people who don’t have an existing chronic illness are excluded from receiving supplemental benefits. Proposed legislation would expand eligibility criteria for special supplemental benefits for the chronically ill (SSBCI) to people who are low-income or are at risk for chronic illness due to socioeconomic factors. The goal is to help address the factors that lead to poor health outcomes and help people get — and stay — healthier.

The bipartisan Addressing Whole Health in Medicare Advantage Act has been introduced in Congress. The legislation is co-sponsored by Rep. Gus Bilirakis (R-FL) and Rep. Earl Blumenauer (D-OR).

“Prevention, education and improving access are essential components of effective public health programs,” said Bilirakis in his 2021 media release about the bill. “Allowing Medicare Advantage programs to target supplemental programs based upon these factors can help to improve patient outcomes for high-risk seniors. This is not just a pragmatic approach, it is the right thing to do as we work to ensure all seniors receive the best possible care."

Industry support

On September 19, 2023, a diverse panel of industry experts gathered on Capitol Hill for a Congressional briefing sponsored by America’s Health Insurance Plans (AHIP). The briefing focused on how MA plans can address SDOH for vulnerable older Americans. Rep. Gus Bilirakis (R-FL) was also in attendance.

Sohini Gupta, AHIP executive vice president of government affairs & innovations, moderated the panel discussion and offered these comments on the introduction of the Addressing Whole Health in Medicare Advantage Act by Rep. Bilirakis. Gupta shared, “Supplemental benefits offered by Medicare Advantage plans address barriers to good health that exist outside of the hospital room or physician’s office. We thank Rep. Bilirakis for the introduction of this bill. By giving Medicare Advantage plans more flexibility, we can dramatically improve the well-being of seniors who are chronically ill, which will result in important savings in the Medicare program for taxpayers.”

Catherine Macpherson, Mom’s Meals® senior vice president of healthcare strategy and chief nutrition officer, was on the panel and shared the company’s support for the legislation and for expanding eligibility criteria to reach more people.

“Our take is that we shouldn’t have to wait for someone to develop a chronic condition before they can access support,” said Macpherson. “Nutrition is preventative and if we can support someone who is food insecure, that should be sufficient enough as it can help them prevent the development of high blood pressure, heart disease, diabetes and more.”

Macpherson reiterated that it’s exactly that kind of experience that everyone should be able to have. “Nourishing the body with the right foods can have a significant impact on one’s health,” she explained. “The supplemental benefits in Medicare Advantage support good nutrition, which is essential in helping people maintain good health and stay out of the hospital or nursing home.”

The benefit of home-delivered meals

During the briefing, Macpherson discussed how offering supplemental benefits like nutritious medically tailored, home-delivered meals programs not only can help MA plans help achieve growth, quality and affordability targets, they also address social determinants or drivers of health (SDOH). Meals that are medically tailored, meaning they are formulated by a registered dietitian nutritionist to meet the nutritional needs of members with chronic conditions, help members improve the management of most common diseases, including hypertension, heart disease, diabetes and more. In addition, meals delivered to the home help address SDOH challenges for members and facilitate access to affordable, nutritious food.

The Addressing Whole Health in Medicare Advantage Act is still pending in Congress, but planners working on MA benefits are taking action now to reach more members with supplemental benefits. Most MA plans currently offer some type of home-delivered meals benefit. KFF reported in 2023, 78 percent of MA plans and 86 percent of Special Needs Plans offered a home delivered meals benefit.

Mom’s Meals can help

Medicare Advantage Plan Product Teams: Improving Outcomes and Star Ratings Through Food and NutritiDuring MA benefits planning time for your product and clinical teams, the experts at Mom’s Meals can help you create an effective and efficient food and nutrition benefit strategy. Get started with the Mom’s Meals Guide for Medicare Advantage Plan Product Teams: Improving Outcomes and Star Ratings Through Food and Nutrition Benefits Design.