The Problem with Medicare Advantage Plans

By Wayne Persky

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Medicare Advantage (MA) plans often advertise dental, vision, and hearing benefits as significant advantages over traditional Medicare (TM). However, a recent study published in JAMA Network Open by researchers from Mass General Brigham reveals that the reality does not match the promise (Cai, et al., 2025).1 Despite offering these supplemental benefits, MA beneficiaries do not typically receive more of these services than their TM counterparts, and out-of-pocket (OOP) spending remains comparable for most services.

Researchers analyzed data from 76,557 Medicare beneficiaries between 2017 and 2021, sourced from the Medical Expenditure Panel Survey (MEPS) and the Medicare Current Beneficiary Survey (MCBS). The study’s goal was to evaluate whether MA plans deliver on their advertised advantages.

How well were the supplemental services utilized?

The study revealed that only 54.2% of MA beneficiaries were aware of their dental coverage, and only 54.3% knew about vision coverage. And the study found that MA enrollees were no more likely to receive eye examinations, hearing aids, or eyeglasses than TM enrollees. Cost-sharing structures and lack of awareness about benefits probably contribute to underutilization.

How did out-of-pocket costs compare?

While out-of-pocket (OOP) costs were slightly lower for MA beneficiaries, the differences were modest:

• Eyeglasses: MA beneficiaries paid $205.86 on average, compared to $226.12 for TM beneficiaries — a 9.0% reduction.
  
• Dental visits: MA beneficiaries paid $226.82 on average, compared to $249.98 for TM beneficiaries—a 9.3% reduction.
  
• There were no significant differences in OOP spending for optometry visits or durable medical equipment (a proxy for hearing aids)

Nationally,

MA plans spent $3.9 billion annually on vision, dental, and durable medical equipment. Beneficiaries themselves paid $9.2 billion OOP, while other private insurers covered an additional $2.8 billion.

The study highlights a troubling inequality.

MA plans receive $37.2 billion more annually from taxpayers than TM plans would have cost for the same beneficiaries. This funding is partly intended to enhance access to supplemental benefits. However, the findings suggest that these additional funds do not translate into significantly greater service utilization or reduced costs for beneficiaries.​

Dr. Christopher Cai, the study's lead author, points out that this raises questions about whether the increased taxpayer investment in MA is justified. "Our findings add to the evidence that this increased cost is not justified," Cai said. The findings challenge one of MA’s key selling points: better access to supplemental services. Senior author Dr. Lisa Simon emphasized that older adults and individuals with disabilities deserve more from Medicare, especially when choosing a MA plan based on advertised benefits.

So the question is, "Why are MA benefits so poorly utilized?"

That question was clearly answered by researchers from Mass General Brigham after they investigated and found significant deficiencies in dental coverage provided by Medicare advantage plans (Simon, Vugicic, and Nasseh, 2024, December 26).2 Despite Medicare Advantage being a privatized alternative to traditional Medicare, offering additional benefits like dental coverage, only a small fraction of plans meet quality standards. The findings, published in JAMA, raise concerns about the accessibility and adequacy of dental care for millions of beneficiaries (Simon, Vujicic, and Nasseh, 2024).3

The researchers found that only 8.4% of Medicare Advantage plans offered a dental benefit that met quality standards comparable to employer-sponsored plans, such as:

• Dental cleanings without co-pay
  
• Annual maximum coverage of at least $1,500.
  
• No additional premium for dental services.
  

While 86.6% of plans included some form of dental benefit, only 4.1% of beneficiaries were enrolled in plans with comprehensive dental coverage. And despite nominal coverage, many plans fall short in providing meaningful access to necessary dental care.

Many plans feature complex benefit structures, such as high co-pays, coverage caps, or limited inclusion of services like fillings and crowns. These complexities can make it difficult for consumers to evaluate plans during open enrollment.

Regulatory oversight is obviously lacking.

The researchers point out the need for stricter regulations to ensure that low-quality dental plans are not offered, thereby protecting consumers. Regulations could also mandate greater transparency, making it easier for beneficiaries to understand the scope and quality of dental benefits.​

With the current lack of adequate regulation, MA plans are reminiscent of bygone times when manufacturers could write ads for snake oil that promised the moon, but only delivered disappointment.

References

1. Cai, C. L., Iyengar, S., Woolhandler, S., Himmelstein, D. U., Kannan, K., and Simon, L. (2025). Use and Costs of Supplemental Benefits in Medicare Advantage, 2017-2021. JAMA Network Open, 8(1):e2454699. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829183

2. Simon, L., Vugicic, M., and Nasseh, K. (2024, December 26). Investigation Uncovers Poor Quality of Dental Coverage under Medicare Advantage. Mass General Brigham, Retrieved from https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/investigation-uncovers-poor-quality-of-dental-coverage-under-medicare-advantage

3. Simon, L, Vujicic, M, and Nasseh, K. (2024). Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County. JAMA, Retrieved from https://pubmed.ncbi.nlm.nih.gov/39724145/