MedPAC: Medicare Paid MA Plans $38 billion for Non-Medicare Services in 2024

[Duaine]

— It's an "enormous amount of money ... we don't track," says one MedPAC member

ast year, Medicare Advantage (MA) plans spent $38 billion on services traditional Medicare doesn't pay for, such as gym memberships, meals, transportation, and dental care.

But a reportopens in a new tab or window presented to the Medicare Payment Advisory Commission (MedPAC) Thursday lamented the agency's inability to evaluate the value of those services, to what extent beneficiaries actually used them, and with which companies the plans contract to provide them.

"Gaps in the data make it difficult for us to assess the value that supplemental benefits may provide to enrollees and to the program," said Stuart Hammond, MPP, MPH, a MedPAC senior analyst.

The independent 17-member commission advises Congress on payment and policy affecting the Medicare program for some 68.4 million beneficiaries, 34.2 million of whom are enrolled in MA plans. Medicare allows MA plans to offer supplemental benefits with the intent they will make patients healthier or improve access to services, and the plans use them heavily to woo enrollees every year.

The report also looked at rebates that Medicare makes to MA plans -- rebates that the plans use in part to pay for these extra benefits. The rebates -- which amounted to $83 billion last year -- are based on costs in each plan's geographic area as well as other factors.

Hammond said that $2,329 was the average rebate amount per beneficiary in conventional MA plans in 2024, but 27%opens in a new tab or window of that went to these non-Medicare services. Those services included annual physical exams, spending allowance for over-the-counter items, acupuncture, a personal emergency response system, and remote-access technologies like an emergency response system and -- in some plans -- safety modifications for the home. The remaining 73% went to pay for drug benefits, reduced Part B premiums and reduced cost-sharing.





[EXTERNAL LINK] - MedPAC: Medicare Paid MA Plans $38 billion for Non-Medicare Services in 2024

For other MA plans targeting populations with special needs, called MA SNPs, the rebate amount was $3,090, with 85% of that going to non-Medicare services.

 

[Millwood]

Me thinks it's time to unleash Doge on Medicare Advantage.

 

[InsuranceGuy29]

Yea, let's yank money away from seniors who are already struggling in an immensely difficult economy. BRILLIANT idea!

Are there any puppies around for these guys to kick too?

These are all benefits seniors use to actually keep a roof over their heads, seeing as how social security amounts to less and less every year with inflation.

These useless NGO's, policymakers, and politicians needs to find something else to do other than sitting around day-after-day for the past 6 years and thinking of how to strip the Medicare Advantage program even further than it already has been.

Find something actually useful to do with your time.

 

[somarco]

The extra items, not covered by Medicare, count towards the loss ratio which seems paradoxical to me.

 

[annon123]

Yea, let's yank money away from seniors who are already struggling in an immensely difficult economy. BRILLIANT idea!

Are there any puppies around for these guys to kick too?

These are all benefits seniors use to actually keep a roof over their heads, seeing as how social security amounts to less and less every year with inflation.

These useless NGO's, policymakers, and politicians needs to find something else to do other than sitting around day-after-day for the past 6 years and thinking of how to strip the Medicare Advantage program even further than it already has been.

Find something actually useful to do with your time.

But on the other hand they are giving billions more to MA so in the end MA clients may come out ahead. It's going to contribute to medicare running out of money earlier than the projected 2036 though. And SS will be cutting benefits earlier than that if they don't get around to fixing that. Seniors are going to be in deep trouble eventually. Sarcastically - this is certainly a way to kill the elderly sooner so the government saves on money with SS and medicare.

 

[Medicare bro]

Stand alone dental is a scam!!! Advantage dental is a steal. Advantage companies need to boil the frog slowly by keeping benefits the same but charging a premium. Start with $10 then each year go up $10 until they hit the sweet spot. Silver sneakers is dying as well, so they can cut that. Focus on medical and care and seniors will continue to flock to part C.

 

[straightnochaser]

Why do you guys want seniors to have shit teeth and pay out of pocket for eyeglasses?

These are popular benefits that GET USED. Get over it ffs!

 

[scagnt83]

Zero reason to spend taxpayer money to subsidize fancy gym memberships for seniors. Or fancy meals. Or grocery cards.

 

[somarco]

From my perspective, there are no "good" dental/vision plans, individual or group.

Some group plans are decent but all have stops embedded in the plans.

 

[InsuranceGuy29]

Zero reason to spend taxpayer money to subsidize fancy gym memberships for seniors. Or fancy meals. Or grocery cards.

There's actually a very good reason...it keeps them healthier and helps keeps a roof over their heads. If you can't help senior citizens, then who can you help? Senior citizens are the ones in society who should have the MOST help.