An elderly woman manages her physical health, from preventive services to specialty care paid for by Medicare. But she struggles with mobility, making tasks such as shopping or cleaning the house challenging. Could there be a way to provide additional assistance to her and others in her situation?
Medicare Advantage supplemental benefits address care gaps that lie outside standard medical care. Learn how this works and how to leverage additional benefits for your members.
The role of Medicare Advantage supplemental benefits
Although Medicare strives to ensure individuals have access to necessary health coverage, members may still need more support. For plans looking to add value for their members and improve costs, Medicare Advantage (MA) can expand access to coordinated care and comprehensive benefits. With supplemental benefits, patients and plans get assistance from outside sources, leveraging private-sector managed care that delivers efficiencies and cost savings.
About supplemental benefits
The Centers for Medicare and Medicaid Services (CMS) requires plans to invest their savings from any newfound efficiencies into health-related benefits that supplement Medicare or lessen member costs. Traditionally, this has translated to a few key areas:
- Reduced cost sharing
- Dental coverage
- Vision coverage
Of course, MA supplemental benefits have evolved in recent years to keep up with member needs.
How supplemental benefits address care gaps
Not all plans realize they have more freedom to offer supplemental benefits that used to be outside the scope of Medicare or Medicare Advantage. Today, benefits don’t have to be strictly medical.
The most common supplemental benefits include:
Recognizing the importance of SDOH
The best thing about supplemental benefits is that they don’t just address physical care. Instead, they improve whole-person health. This means that plans have become more aware of social determinants of health (SDOH).
Social determinants of health — including where people live, their age, and social, behavioral and environmental factors — can influence larger health outcomes. By taking SDOH into account, plans can address health-related social needs, centering efforts on individual patients and integrating them into care plans. Solving for unmet SDOH needs can reduce the number of ER visits and readmissions.
Testing new benefits
By incorporating supplemental benefits and honing in on SDOH needs, MA plans can experiment with what works best for members. Taking steps in this direction opens doors to improve care and outcomes for vulnerable and at-risk members.
Are you curious about what this could look like? MA plans like yours might consider piloting efforts designed to:
- Reduce loneliness.
- Enhance the coordination between physical and mental health.
- Improve medication management.
Care must extend beyond obvious medical treatments because humans are infinitely more complex than a single diagnosis. Supplemental benefits can fill the gap with care offerings that account for medical and behavioral health needs, SDOH and the whole person.
Help YOUR members with benefits that go above and beyond
Standard Medicare benefits don’t cover everything a person may need to live an optimal life. Medicare Advantage supplemental benefits pick up the slack on personal needs that often impact health outcomes, providing important savings.
Pyx Health also makes it easier to address care gaps. Our platform focuses on SDOH by addressing loneliness and isolation to improve health outcomes and increase engagement. With access to the solution, members can get early interventions through a combination of direct human connection with our experienced ANDYs (Authentic, Nurturing, Dependable, Your Friend) and access to a science-based mobile app, providing the right resources at the right time.
