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MA plans' LTSS supplemental benefits have untapped potential

Despite a 2018 rule allowing more LTSS supplemental benefits in Medicare Advantage, the share of plans offering them has gone down.

Sara Heath
By
Published: 14 Aug 2025

Despite a 2018 rule expanding the Medicare Advantage plans' allowable supplemental benefits to include long-term services and supports, there's a lot of untapped potential, according to a new study in JAMA Network Open.

Specifically, the share of Medicare Advantage (MA) plans offering long-term services and supports (LTSS) benefits has actually gone down since the aforementioned rule, as has the proportion of members enrolled in plans with LTSS benefits.

These findings come as the nation grapples with a growing Medicare population. MA is increasingly becoming the biggest source of Medicare coverage, the researchers said, and having benefits in place to support patients and their family members will be key.

Background

In 2018, the Centers for Medicare & Medicaid Services expanded the definition of "primary health-related supplement benefits" that could be offered under MA. Some of those supplemental benefits included LTSS, such as home health aides or even in-home medical equipment.

"More than half of adults older than 65 years require some form of LTSS, with a desire to age in place in the community as opposed to nursing homes," the researchers explained in the study's introduction. "Increased provision of LTSS improves outcomes for patients and reduces healthcare costs, and providing LTSS in home or community settings can delay or potentially avoid the more expensive alternative of older adults being shifted to nursing homes."

The move from CMS allowed MA plans to include LTSS as part of their benefits packages. However, according to the researchers, expanded LTSS benefits didn't come to fruition.

MA plans largely did not integrate LTSS benefits

The researchers assessed 4,521 MA plans from 2019 and 6,614 from 2025 to analyze the growth -- or lack thereof -- in LTSS benefits, finding a net increase in plans that included LTSS benefits. In 2019, there were 581 plans that offered LTSS benefits; by 2025, that number had increased to 814.

But despite increases in the absolute number of MA plans offering LTSS benefits, the percentage of plans offering LTSS benefits decreased from 12.9% to 12.3% during the study period.

What's more, fewer members were enrolled in plans offering LTSS supplemental benefits. In 2019, 21.4% of members were enrolled in such plans. By 2025, that number decreased to 7.9%.

Indeed, some of that decrease could be explained by reductions in market share for some MA plans, the researchers said. This was especially true prior to 2023.

"However, since 2023, the share of MA beneficiaries enrolled in plans offering LTSS has decreased, whereas there were no noticeable changes in the average plan size," the researchers wrote. "This finding seems to imply that, at least in more recent years, the decrease in enrollment in such plans is driven by the reduction in plans offering LTSS rather than existing plans losing market share."

The researchers indicated that the addition of LTSS might not be financially viable for some MA plans, while potential enrollees might not value these types of supplement benefits.

Still, there is room for more investigation on this front. For one thing, newer MA plans tended to have more generous LTSS benefits than older ones, indicating a primed playing field for these types of benefits, the researchers said. However, it will be important to gain a better understanding of beneficiary characteristics and workforce bandwidth and capabilities.

Sara Heath has covered news related to patient engagement and health equity since 2015.

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