Medicare Advantage's Provision of Expanded Supplemental Benefits and Acute Care Utilization

Objective: To examine whether Medicare Advantage (MA) plans' provision of expanded supplemental benefits reduces enrollees' acute care utilization. Expanded supplemental benefits included non-medical primarily health-related (PHR) benefits such as in-home support services, starting in 2019, and Special Supplemental Benefits for the Chronically Ill (SSBCI) such as food security and housing quality benefits, starting in 2020. Study Setting and Design: Quasi-experimental design using staggered difference-in-differences models. We created indicators for offering the following benefits: Any expanded PHR, ≥ 2 expanded PHR, any SSBCI, and ≥ 2 SSBCI. Acute care utilization was measured by three binary indicators of adverse health events: annual emergency department (ED) use, hospitalizations, and re-admissions. Data Sources and Analytic Sample: We used 2017–2022 MA encounter data from a random 20% sample of enrollees. We estimated separate models for each benefit indicator, for all non-dual and all dual-eligible enrollees, and for highly frail patients within each non-dual and dual-eligible group. We used propensity score matching to balance baseline characteristics between treatment and control groups. Principal Findings: Offering expanded supplemental benefits did not generally reduce acute care utilization in all non-dual or all dual-eligible enrollees. A few significant effects were relatively small or were not robust to potential differential trends between benefit-offering and not-offering plans. However, among highly frail non-dual enrollees, offering any PHR reduced re-admissions by −2.82 percentage points (95% CI: −4.78, −0.86), offering ≥ 2 expanded PHR reduced hospitalizations by −1.79 percentage points (95% CI: −2.61, −0.98) and ED use by −1.76 percentage points (95% CI: −2.38, −1.14), and offering ≥ 2 SSBCI reduced ED use by −3.51 percentage points (95% CI: −4.96, −2.05) and hospitalizations by −2.05 percentage points (95% CI: −3.12, −0.099). Conclusions: Provision of expanded supplemental benefits may reduce acute care utilization for certain enrollees. As spending on MA supplemental benefits rises, continued efforts are needed to assess impacts of those benefits.