Medicare Advantage Can Help Address Health-Related Social Needs

While we may not directly connect things like housing instability or transportation issues to health care, it’s often all intertwined.

 Think about it this way, if you can’t pay your electricity bill and you have no heat when the temperature outside is below freezing, that can have a negative impact on your health. If you don’t own a vehicle and live too far away from public transportation, you may choose to forgo a visit to the doctor when you start to notice symptoms of a potential health problem. Or, if your budget is tight, one unexpected expense might mean you suddenly have to choose between buying groceries and paying for necessary medications.  

These challenges can certainly take a toll on health and well-being if they aren’t addressed. In fact, health-related social needs (HRSNs) are strongly associated with higher rates of hospitalizations and visits to both care providers and emergency rooms.

In a recent study, Humana Healthcare Research found that 80% of dual-eligible individuals are experiencing at least one HRSN – the average was 2.2 HRSNs per beneficiary in the study. Dual-eligible beneficiaries, those who are eligible for both Medicare and Medicaid, make up close to 20% of all Medicare beneficiaries and nearly 15% of all Medicaid beneficiaries across the nation.

Our research found the most commonly reported HRSN was financial instability, with around three of every five dual-eligible beneficiaries indicating this is a challenge for them. About half of dual-eligible beneficiaries said they have experienced food insecurity.

Fortunately, we are able to design Medicare Advantage plans that go beyond the typical benefits covered through health insurance, so we can be more proactive when it comes to HRSNs. Addressing HRSNs is much like preventive health care – the sooner we discover any potential issues, the more likely it is we can do something about it before it’s too late.

Health insurance carriers may offer plans designed to address the needs of dual-eligible beneficiaries. Many of these Dual-eligible Special Needs Plans, or D-SNPs, now include monthly allowances that can be used to pay for essential needs like food, rent and utilities to help alleviate some of the HRSNs individuals and families are facing. For example, all of Humana’s D-SNP members receive a Healthy Options allowance, which provides between $35 and $275 per month, depending on the plan and location. That’s $420-$3,300 annually that members can use to pay for eligible expenses that have an impact on their health and well-being.

D-SNPs also use a care team approach, which can help members address their specific HRSNs. Whether it’s assistance with benefits and medical services or with guidance about where to find community resources, like transportation, food assistance and other social support services, having access to comprehensive care makes it easier for members to manage their health.

As we think of health care more holistically by understanding the social and environmental factors that may be impacting an individual’s health, we can take a more proactive approach to helping people lead healthier lives.