Abstract
IMPORTANCE: Medicare Advantage (MA) plans have had the ability to offer long-term services and supports (LTSS) supplemental benefits (eg, in-home support services, adult day health services, caregiver support, home-based palliative care, and nonopioid pain management) since 2019. However, it is largely unknown how available these benefits currently are among MA plans. OBJECTIVE: To examine the prevalence of LTSS supplemental benefits among MA plans and enrollment within these plans. DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used publicly available Centers for Medicare & Medicaid Services data on MA plan benefits and enrollment from January 2019 to April 2025 to examine changes in the offering of and access to LTSS supplemental benefits among MA plans as well as the enrollment within such plans. The analysis was limited to those MA plans that were identified as health maintenance organization or preferred provider organization plans. Data analyses were performed from November 2024 to March 2025.21.4. MAIN OUTCOMES AND MEASURES: MA plans offering LTSS supplemental benefits, the share of MA beneficiaries enrolled in a MA plan with LTSS benefits at the county level, and benefit generosity between newer and older MA plans. RESULTS: In this study of 4521 MA plans in 2019 and 6614 MA plans in 2025, the number of MA plans offering any LTSS benefits increased from 581 to 814 from 2019 to 2025; however, the share of such plans slightly decreased from 12.9% to 12.3%. A mean (SD) of 21.4% (20.9%) of MA beneficiaries at the county level were enrolled in plans offering supplemental benefits in 2019, which decreased to 7.9% (12.7%) in 2025. The share of plans offering in-home support services, adult day services, home-based palliative care, and nonopioid pain management increased by 4.6, 0.02, 1.1, and 1.9 percentage points, respectively, whereas caregiver support services decreased by 5.6 percentage points. Lastly, when comparing newer and older MA plans offering LTSS benefits, newer MA plans offered 0.59 (95% CI, 0.48-0.70) more benefits than older MA plans. CONCLUSIONS AND RELEVANCE: In this cohort study, the availability of LTSS benefits within MA plans in 2025 was essentially no different than it was when benefits were first offered. The share of MA beneficiaries enrolled in a plan offering LTSS decreased during the same time frame, suggesting that there is still untapped potential for MA plans to offer LTSS supplemental benefits.