Medicare Advantage: How do you use benefits you don’t know you have?

By Phil Wilkins
Nutritious Meals

For 20 years I was in the foodservice industry as a restaurant owner. During that time I came across employees who faced challenges every day. At the time, I recognized many of our people went through tough times, but I viewed this as a “personal issue,” and I believed these employees should have dealt with the problems before they got to work. My mindset, like many Type A personality business leaders, was one of “We have a job to do” and “Check it at the door.”

Looking back all these years later I could have had—I should have had—more compassion. I didn’t fully realize the extent of issues that become a constant battle for so many people. These battles can’t be left at the door; they are all-encompassing.

At the time I felt I was somewhat empathetic, but did I really do enough to help, and if I helped more would I have been able to save an employee from turnover, or helped that employee change the trajectory of their life? I’ll never know, and I regret that to this day.

Today, I have a different outlook not only on the restaurant industry’s interaction with employees but on underserved and food-insecure populations more broadly. Rather than discounting people because of their home life or living situation, it’s time to reach out and help during difficult times.

Many times that help involves simply letting people know that certain benefits to which they’re entitled exist. People enrolled in Medicare Advantage plans, for example, have access to free or low-cost nutritional meals, but may be unaware they’re eligible for the benefit.

As Medicare Advantage enrollment is in full swing, October 15, 2021 through December 7, 2021, it’s critical to let older adults know that meals eligibility has increased among these plans. “Medicare Advantage plans are deploying multiple strategies to address social determinants of health,” including food insecurity.

A comparison of Medicare Advantage plans shows that in 2022 among the most common benefits are meals and nutrition.

Meal benefits among Medicare Advantage plans increased from 55% in 2021 to 68% in 2022. Nutrition benefits grew as well from 17% in 2021 to 30% in 2022, according to Avalere. Forty percent of Medicare Advantage plans offer the meal benefit at no cost.  

Taking advantage of these benefits is an important way to battle food insecurity, which remains a significant problem among older adults.

Identifying, acting on food insecurity challenges

We know food insecurity has always existed; the pandemic has only magnified it among populations young and old. “Prior to COVID-19,” explain researchers in the Journal of Hunger & Environmental Nutrition, “wide disparities in food insecurity were stark with rates elevated above the national average for poor households, households with children, single-parent households, people living alone, and Black- and Hispanic-headed households.”

When the pandemic hit, employees were laid off or put on furlough, supply chains collapsed, runs on grocery stores for paper goods and food became commonplace. “The overnight shutdown of restaurants, schools, worksites, and many other institutions due to COVID-19 increased demand for food at home and created food supply disruptions in grocery stores and the charitable feeding system,” according to the American Journal of Clinical Nutrition. “Ultimately, the pandemic will exacerbate existing disparities in food insecurity and chronic disease, which will persist after the pandemic.”

People who are food insecure face many challenges that are often compounded by where they live, whether they’re working or unemployed, their age and even their race. When decisions must be made between food and basic life necessities…these are dire and tough situations that too many people face today.

Pandemic-related issues exacerbated an already fragile community-based food-security system as many people faced unexpected difficulties:

  • New or ongoing economic disparity
  • Chronic and acute health conditions
  • Faltering health caused by a poor diet
  • New household stressors

Whether we’re in the middle of a pandemic or living through a “regular” year, many families worry each day about when and where they’ll get their next meal. In two low-income African American Pittsburgh neighborhoods during the pandemic, food insecurity grew nearly 80% from March to May 2020. “COVID-19 has magnified preexisting racial/ethnic disparities in food security in a very short time, a circumstance linked to a wide variety of health outcomes. We observed a significant spike in food insecurity during the first weeks of the pandemic that far outpaced the increase in the general US population,” the researchers found.

Many times, however, older adults living in neighborhoods designated as food deserts simply don’t know that they have access to better, more healthy choices. Even with inexpensive, less-than-desirable food options, 24% of Americans continue to worry about having enough to eat.

This lack of knowledge sometimes forces people to make the extremely difficult choice between food and medication or food and clothing or food and housing. Each is an attempt to balance dollars and the negative effect of picking one over another. “(F)or those who expressed worry about themselves not having enough to eat, more than one-third (37%) said that they didn’t have enough money to buy food while another 30% said that they used their money to purchase other necessities,” according to The Root Cause Coalition.

These are difficult, all-consuming decisions that must be made every day by the most vulnerable members of the population. It’s a huge problem. So much so that 76% of Americans say addressing hunger should be a top priority for policymakers. Hope is not lost and there is a growing opportunity for us to take responsibility and action. The healthcare industry and community-based organizations can work together on addressing food insecurity through the lens of social determinants of health.

What you don’t know can hurt you

Some amount of food insecurity in the U.S. can be prevented through Medicare Advantage programs, especially as we enter 2022 with the growth of the meal benefit. There are approximately 5 million older adults nationwide, or three of five people eligible for food benefits, but not using the entitlement.

Food Research & Action Center data show food benefit participation among older adults continues to drop precipitously in many states with an average participation rate of approximately 24% nationwide. Even the states with the highest participation rates miss helping many eligible older adults. New York state, for example, has the highest number of older adults receiving food benefits at 70%, leaving a significant number of people eligible, but not taking advantage of the food aid. On the other end of the spectrum, California has the lowest participation rate at about 19%.

Access to and knowledge of the availability of nutritious meals is just part of the problem. For those not participating in a food benefit program, the lack of healthy food may impact their short- and long-term health and well-being. One study showed there are decided health benefits for older adults who participate in the program. The study of 60,000 low-income older adults in Maryland found that participants who took advantage of the food benefit were 23% less likely to enter a nursing home and 4% less likely to be hospitalized than those who don’t take participate.

A ten-year study of more than 6,600 older adults found that participating in a food program decreased hospitalizations by nearly 46% compared to non-participants. “Millions of eligible seniors who do not participate…may be at increased risk of hunger and hunger-related health problems, such as diabetes, hypertension, and depression,” according to Food Research & Action Center.

There’s much we can do to help reduce food insecurity nationwide simply by helping to improve access to subsidies that already exist but are underused or not used at all. The first step is helping to ensure each person who’s eligible takes advance of the benefits they’re entitled to receive.

By taking this small step, we can help lessen the negative impact of food insecurity. Years ago, I should have done more by letting people know about the benefits available to them. This time I’m not waiting to reach out to those who need some extra help. I’m doing it now. Today.

Phil Wilkins is Senior Vice President of Social Determinants of Health at Modivcare.