Medicare Advantage Enrollees Underuse Dental, Vision, Hearing Benefits

Medicare Advantage (MA) enrollees do not utilize dental, vision, and hearing benefits at higher rates compared with traditional Medicare (TM) beneficiaries, despite these benefits being included in nearly all MA plans, according to new research.¹ The findings suggest that low awareness of coverage and cost-sharing requirements may contribute to this underuse.

MA enrollees underuse dental, vision, and hearing benefits despite coverage. | Image credit: © Maksym Yemelyanov - stock.adobe.com

Although MA plans spent an estimated $3.9 billion annually on these supplemental services, enrollees still faced significant out-of-pocket (OOP) costs totaling $9.2 billion per year, supplemented by $2.8 billion from other private insurers, underscoring the need for improved benefit education and cost management to enhance service utilization.

This cross-sectional study of 2 nationally representative surveys is published in JAMA Network Open.

“Nearly all MA plans report coverage of supplemental benefits,” wrote the researchers of the study. “However, in this national cross-sectional study, non–dually eligible MA beneficiaries did not receive more dental, vision, or hearing care than TM beneficiaries. This finding held even among subgroups with a specific medical need for such services, such as individuals with hearing loss who require hearing aids.”

In 2024, those enrolled in individual plans had access to eye exams and/or eyeglasses (100% in 2023 and 2024) and dental benefits (98% in both years), according to KFF.² Access to hearing exams and/or aids saw a slight decline, from 99% in 2023 to 96% in 2024. Overall, despite concerns about payment changes reducing benefits, the share of enrollees in plans offering these services has remained stable or increased since 2015.

The study analyzed data from the Medicare Current Beneficiary Survey (MCBS) and the Medical Expenditure Panel Survey (MEPS) from 2017 to 2021, focusing on coverage, use, and costs of supplemental dental, vision, and hearing benefits among MA and TM enrollees.¹ Statistical analyses adjusted for the demographic variables age, sex, race, education, and income. Additional analyses assessed year-by-year changes, including the impact of the COVID-19 pandemic. Analyses were conducted from September 2023 to June 2024.

A total of 76,557 non–dually eligible Medicare beneficiaries were included, with 23,404 from the MEPS and 53,153 from the MCBS. The demographic characteristics of MA and TM enrollees were comparable, with similar proportions of females (54.7% vs 51.9%, respectively) and beneficiaries older than 75 years (39.8% vs 35.2%).

Despite MA plans offering supplemental benefits, only 54.2% and 54.3% of MA enrollees were aware of their dental and vision coverage, respectively. There were no significant differences between MA and TM enrollees in the likelihood of receiving eye exams, hearing aids, or eyeglasses.

Adjusted OOP spending was slightly lower for MA enrollees compared with TM enrollees for eyeglasses ($205.86 vs $226.12; −$20.27 [9.0%]) and dental visits ($226.82 vs. $249.98; −$23.16 [9.3%]), while spending on optometry visits and durable medical equipment (a proxy for hearing aids) showed no significant differences.

The study had limitations. First, the results were descriptive and may have been influenced by residual confounding due to unmeasured differences between MA and TM enrollees. Further, medical expenditures were likely underestimated in the MEPS, which excludes institutionalized individuals, such as nursing home residents. Additionally, the use of durable medical equipment costs as a proxy for hearing aid expenditures may have led to an overestimation of MA spending by approximately $520 million annually.

Despite these limitations, the researchers believe the study found that although more MA enrollees have coverage of supplemental benefits, MA enrollment does not appear to be associated with more use of these services.

“MA enrollees’ limited use of supplementary services may reflect their lack of awareness of coverage for those services, as only one-half of MA beneficiaries reported dental or vision coverage, or barriers posed by cost-sharing imposed by plans, which covered only one-fourth of the total costs of dental, vision, and hearing services for MA beneficiaries,” wrote the researchers.

References

1. Cai CL, Iyengar S, Woolhandler S, et al. Use and costs of supplemental benefits in Medicare Advantage, 2017-2021. JAMA Netw Open. 2025;8(1):e2454699. doi:10.1001/jamanetworkopen.2024.54699

2. Freed M, Biniek JF, Damico A, et al. Medicare Advantage in 2024: Premiums, out-of-pocket limits, supplemental benefits, and prior authorization. KFF. August 8, 2024. Accessed January 14, 2025. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2024-premiums-out-of-pocket-limits-supplemental-benefits-and-prior-authorization/.