Medicare Advantage enrollees with diabetes aren't healthier than Americans on traditional Medicare - despite the grocery and gym perks

A new study examined whether people who enroll in Medicare Advantage plans see improvements in hemoglobin A1C, blood pressure, LDL cholesterol and other common biomarkers associated with Type 2 diabetes.

Older adults with diabetes in Medicare Advantage plans don't have better health than those with traditional Medicare, even with extra benefits like a grocery allowance or a gym membership.

An observational study, published earlier this month in JAMA Internal Medicine, looked at 35,000 adults with Type 2 diabetes for 31/2 years. It found that the 45% who enrolled in a Medicare Advantage plan during that time didn't see improvements in biomarkers commonly associated with diabetes, such as hemoglobin A1C, LDL cholesterol or blood pressure.

The study didn't give a reason. But Seth Berkowitz, the lead researcher and a primary-care physician in the UNC Health hospital system in Chapel Hill, N.C., wondered if it's because the supplemental Medicare Advantage benefits that appeal to seniors with diabetes, like food allowances and prepaid cards that can be used to buy over-the-counter diabetes supplies, aren't always easy to access.

"Even though these benefits exist on paper for people, they're probably not reaching a lot of people," he said.

Medicare Advantage plans are offered by private health-insurance companies as an alternative to traditional Medicare. In exchange for narrower networks and stricter prior-authorization rules, enrollees can choose plans with extra benefits, such as dental and vision coverage, prepaid debit cards to buy healthy food, or transportation to the doctor. About 10 million seniors enrolled in plans with a food and produce benefit in 2025.

In general, Medicare Advantage plans, which sometimes have no monthly premiums, are popular, covering 55% of all Medicare beneficiaries this year. These enrollees tend to be sicker and poorer than those on traditional Medicare. These plans are under scrutiny for several reasons, including the supplemental benefits they offer.

"One of the most challenged areas in Medicare is really the supplemental benefit experience," said Sachin Jain, CEO of the nonprofit health insurer SCAN Group, which announced last week that it's developing a Medicare Advantage plan with Costco $(COST)$.

"Many people feel like they've been subjected to a bait-and-switch in supplemental benefits," he said. "Plans will market themselves with really fancy, really generous-sounding supplemental benefits, and then, when people go to use them, they realize that there's a restricted network, or they'll realize that the $1,000 of over-the-counter credits that they've been given come with inflated prices that insult your intelligence."

Back in 2024, three in 10 Medicare Advantage enrollees said they didn't use any of their supplemental benefits that year, and less than 10% used their grocery allowance or meal-delivery benefits, according to the Commonwealth Fund. These benefits are often used to market plans to enrollees.

The other major criticism of Medicare Advantage is how much the federal government spends on enrollees in these plans. The U.S. spends 14% more on Medicare Advantage enrollees than those in traditional Medicare, according to Medpac, an independent agency that advises Congress on Medicare. That's due in part to "coding intensity," meaning the inclusion of more diagnoses for Medicare Advantage enrollees. These diagnoses are incorporated into a Medicare Advantage risk score for each enrollee; the higher the risk score, the higher the payment.

Even with more dollars going to Medicare Advantage plans, there's a growing body of research that shows that spending isn't helping Americans better manage chronic conditions like heart failure or diabetes, a condition that affects about 20% of older adults. A 2022 study found that enrolling in a Medicare Advantage plan didn't lead to improvements in older adults with diabetes.

"That higher spending could be worthwhile if it is accompanied by better health," Berkowitz and his fellow researchers wrote.

-Jaimy Lee