Social Needs Screening and Supplemental Benefits in Medicare Advantage

ABSTRACT

Objectives: Social determinants of health (SDOH) impact the health outcomes of older adults. Recognizing the importance of screening for and addressing social needs, CMS allowed Medicare Advantage (MA) plans to begin offering SDOH screening and providing social needs–oriented Special Supplemental Benefits for the Chronically Ill (SSBCI) in 2024. In this article, we describe MA plans that screen for SDOH and provide SSBCI addressing social needs, and we explore how offerings align with communities’ social needs.

Study Design: Retrospective, cross-sectional descriptive analysis.

Methods: We analyzed 2024 MA Plan Benefit Package and enrollment files and SVI data. We assessed the number of and enrollment in plans and their geographic distribution compared with SVI, a measure to quantify social needs.

Results: In the first year of implementing screening for SDOH, MA plans had low uptake (20% of plans). Of plans that screened for SDOH, approximately half offered interventions to address SDOH through SSBCI; most screened for SDOH and offered SSBCI in communities with greater social need, but many of the highest-need areas had no such plans.

Conclusions: These findings highlight the opportunity to expand SDOH screening and SSBCI, particularly in areas with the highest social needs, as MA becomes the largest provider of health care for older adults.

Am J Manag Care. 2026;32(6):In Press

Takeaway Points

Starting in 2024, Medicare Advantage (MA) plans were allowed to begin screening for social determinants of health (SDOH) and providing social needs–oriented Special Supplemental Benefits for the Chronically Ill (SSBCI). In this article, we describe MA plans that screen for SDOH and provide SSBCI addressing social needs, and we explore how offerings align with communities’ social needs. The following findings highlight an opportunity to expand SDOH screening and SSBCI, particularly in areas with the highest social needs, as MA becomes the largest provider of health care for older adults.

• In the first year after CMS implemented SDOH screening, only 19.8% of MA plans screened for SDOH.
• Among MA plans that screened for SDOH and offered interventions for SDOH, Special Needs Plans and in particular Dual-Eligible Special Needs Plans were predominant.
• Although more plans screened for SDOH and offered SSBCI in communities with greater social need, many of the highest-need areas had no such plans.

Approximately 33% to 80% of health outcomes are attributable to social determinants of health (SDOH), with more than half of Medicare Advantage (MA) beneficiaries reporting social needs.^1,2 Starting in 2024, CMS allowed MA plans to both provide SDOH screening for health-related social needs and social needs–oriented Special Supplemental Benefits for the Chronically Ill (SSBCI) aimed at addressing issues such as food insecurity, transportation for nonmedical needs, air quality equipment, and structural home modifications.^3,4 However, little is known about the extent to which MA plans screen for and provide such benefits and how these offerings align with communities’ social needs.

METHODS

We analyzed 2024 MA Plan Benefit Package and enrollment files and Social Vulnerability Index (SVI) data.^5,6 We grouped MA plans by SDOH screening status (screening vs nonscreening plans). Within each group, we distinguished between plans offering vs not offering SSBCI to create 4 plan groups: screening plans offering SSBCI; screening plans not offering SSBCI; nonscreening plans offering SSBCI; and nonscreening plans not offering SSBCI. SSBCI address social needs and are categorized in eAppendix Methods (available at ajmc.com). Plan type was defined as health maintenance organization, preferred provider organization, or other. We excluded employer-sponsored plans given their lack of availability to most MA beneficiaries.

We assessed the number of and enrollment in plan groups across 2024 overall, among Special Needs Plans, and among Dual-Eligible Special Needs Plans. We also assessed the geographic distribution of screening plans offering SSBCI (county-level number of plans, separated into quintiles) and of social needs (county-level SVI, separated into quintiles, with the lowest quintile reflecting areas with the least social needs and the highest quintile reflecting areas with the greatest social needs). Finally, we assessed the median number of screening plans offering SSBCI within each SVI quintile. This study met criteria for non–human participants research.

RESULTS

In the US in 2024, 19.8% (n = 1520) of MA plans were screening plans, representing 12.2 million beneficiaries (Table). Screening plans were more likely to offer SSBCI than nonscreening plans (56.1% vs 16.6%).

Nearly two-thirds of Special Needs Plans (62.8%; n = 869) were screening plans; of those, nearly three-fourths (73.1%; n = 635) offered SSBCI. Among Dual-Eligible Special Needs Plans in particular, 89.4% (n = 790) were screening plans and 71.1% (n = 562) of those plans offered SSBCI. Among both screening and nonscreening plans, health maintenance organization plans were more common than preferred provider organization plans.

Overall, 79.2% of US counties had screening plans offering SSBCI. Counties with the most screening plans offering SSBCI (top quintile) were in the Northeast, South, Midwest, and West (Figure [A]). Counties with the greatest social needs (top quintile) were located primarily in the South and West (Figure [B]).

The number of screening plans offering SSBCI corresponded with area social need: Counties with the lowest social needs had a median of 4 screening plans offering SSBCI, whereas counties with the greatest social needs had a median of 8 such plans (Figure [C]). However, 15.9% of the greatest-need counties did not have any screening plans offering SSBCI.

DISCUSSION

Although screening for SDOH and offering SSBCI were common among Special Needs Plans, particularly Dual-Eligible Special Needs Plans, broader national uptake was limited. More plans screened for SDOH and offered SSBCI in communities with greater social need, but many of the highest-need areas had no such plans.

Limitations include that this descriptive analysis was limited to plan-level data. Additionally, plans with 10 or fewer beneficiaries enrolled were not available in our data set, in compliance with the Health Insurance Portability and Accountability Act.

Nonetheless, these findings first highlight opportunities to increase SDOH screening and link screening with interventions—particularly in the highest-need areas, where more than 1 in 6 communities lack any plans that both screen for need and offer supplemental benefits. Second, more work is needed to understand why some of the highest-need areas did not have any such plans.

Author Affiliations: Department of Plastic Surgery, The University of Texas Southwestern Medical Center (JIB), Dallas, TX; Program on Policy Evaluation and Learning (JIB, JRC, JHJ, JML), Dallas, TX; Division of General Internal Medicine, Department of Internal Medicine, The University of Texas Southwestern Medical Center (MDD, JRC, JHJ, JML), Dallas, TX.

Source of Funding: None.

Author Disclosures: Dr Joo receives royalties from Wolters Kluwer. Dr Liao reports service on the Medicare Payment Advisory Commission and the Physician-Focused Payment Model Technical Advisory Committee and grants received from the Agency for Healthcare Research and Quality, Arnold Ventures, National Institute on Minority Health and Health Disparities, and Patrick and Catherine Weldon Donaghue Medical Research Foundation. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JIB, JML); acquisition of data (MDD, JML); analysis and interpretation of data (JIB, MDD, JRC, JHJ, JML); drafting of the manuscript (JIB, MDD, JRC, JHJ); critical revision of the manuscript for important intellectual content (JIB, JRC, JHJ, JML); statistical analysis (MDD); and supervision (JIB, JML).

Address Correspondence to: Jessica I. Billig, MD, MSc, Department of Plastic Surgery, The University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75390. Email: jessica.billig@utsouthwestern.edu.

REFERENCES

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