CMS heeds AOA recommendations on Medicare supplemental benefits

May 2, 2024
Meaning to provide greater transparency and lower frustration and confusion among beneficiaries with Medicare Advantage plans, the Centers for Medicare and Medicaid Services is rolling out new procedures to communicate and to educate its enrollees on accessing their benefits.
Deanna Alexander, O.D. video

Changes to Medicare Advantage (MA), including sending mid-year notices to beneficiaries on the up-to-date utilization of their supplemental benefits, reflect AOA advocacy on behalf of doctors of optometry and patients

Among typical MA supplemental benefits are vision care and dental services. Starting in June 2026, MA plans will now be required to issue to Medicare enrollees mid-year reports on the status of their supplemental benefits, specifically notifying enrollees how much of their benefits had not been utilized by them during the first six months of the calendar year, Jan. 1-June 30.

The notice must also inform beneficiaries about the scope of the benefit, cost-sharing, instructions on how to access the benefit, any network application information for each available benefit and customer service contact information if additional help is needed. Previously, MAs had not been required to send the info to beneficiaries.

“This policy aims to educate enrollees on their access to supplemental benefits, to encourage greater utilization of these benefits and ensure MA plans are better stewards of the rebate dollars directed toward these benefits,” according to the Centers for Medicare & Medicaid Services’ (CMS’) final rule on changes to the Medicare program published April 23 in the Federal Register.

Says Deanna Alexander, O.D., chair of the AOA’s Federal Relations Committee: “These changes are a very big deal for doctors of optometry. Medicare Advantage plans are becoming more prevalent in the marketplace. Having CMS recognize the need to be more transparent when offering supplemental benefits to their enrollees is significant and will be better for patients and doctors. This builds upon other policy changes that AOA has advocated for in order that seniors get the care they need and deserve.”

Over the past several years, the AOA has advocated for greater oversight of MA plans and thus far, CMS has been responsive to its concerns.

AOA: ‘Unwavering advocacy’ over Medicare Advantage

The notification is among a number of noteworthy changes by CMS to increase transparency regarding vision benefits under MA. Other changes:

The changes follow five years of unwavering education and advocacy by the AOA to CMS, Dr. Alexander says. She noted that doctors and staff are on the front lines of explaining coverage to patients, confused at times by the scope of their insurance and even who can provide the services.

A fall 2023 survey found that “an overwhelming 96% of doctor of optometry respondents indicated they have cared for Medicare Advantage patients that are angry or unhappy with their coverage and benefits. Because patients are often confused regarding the scope of their supplemental vision benefits, clarity in any mid-year notice is critical,” the AOA said in the letter to CMS on Jan. 5.

“This also causes barriers to care when patients are accessing medical care, because they don't understand their supplemental benefits are for a preventative eye exam and may be offered through a subcontracted vision plan,” Dr. Alexander says. “Patients may not understand or realize that the provider for the supplemental vision plan is not a part of the medical plan, which creates additional confusion for patients.

“AOA appreciates that CMS has recognized in the new rule that Medicare Advantage plans can be more transparent and better educate enrollees about their benefits,” she adds. “Out of better understanding by seniors, beneficiaries will be more likely to access the care they need.”

Currently, MA plans have characterized as “low” the use of these supplemental benefits.

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