Medicare Advantage: Informing Beneficiaries to Address SDoH, Reduce Food Insecurity

For 20 years, I was in the food service industry as a restaurant owner. I came across employees who faced challenges every day. At the time, I viewed their challenges as personal issues, and I believed these employees should have dealt with the problems before they got to work. My mindset, like that of 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 and should have had more compassion. I didn’t fully realize the extent of issues that can become a constant battle for so many people. These battles can’t be left at the door; they are all-encompassing.

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 personal 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 (MA) plans, for example, have access to free or low-cost nutritional meals but may be unaware they’re eligible for the benefit.

As MA enrollment is in full swing from October 15, 2021, through December 7, 2021, it’s critical to let older adults know that meals eligibility has increased among these plans. MA plans are increasingly prioritizing social determinants of health, including food insecurity.

A comparison of MA plans shows that meals and nutrition are among the most common benefits to be offered in 2022. The number of MA plans offering meal benefits is set to increase from 55% in 2021 to 68% in 2022. Likewise, the number of plans offering nutrition benefits is projected to increase from 17% in 2021 to 30% in 2022. 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 and Acting on Food Insecurity Challenges

We know food insecurity has always existed; the pandemic has only magnified it among populations of all ages. When the pandemic hit, employees were laid off or put on furlough, supply chains collapsed, and runs to 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 a review published in the American Journal of Clinical Nutrition.

Before the pandemic, “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,” explain researchers in the Journal of Hunger & Environmental Nutrition.

Researchers found that COVID-19 amplified preexisting racial and ethnic food security disparities, which in turn impact health outcomes. For instance, in two low-income Pittsburgh neighborhoods with predominantly Black residents, food insecurity grew nearly 80% from March to May 2020.

People who are food insecure face many challenges that are often compounded by where they live, their employment status, their age, and their race. Pandemic-related issues exacerbated an already fragile community-based food-security system as many people faced unexpected difficulties such as:

• new or ongoing economic disparities;
• chronic and acute health conditions;
• faltering health caused by a poor diet; and
• 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 from where they’ll get their next meal. And even with inexpensive, less-than-desirable food options, 24% of Americans continue to worry about having enough to eat.

Many times, older adults living in neighborhoods designated as food deserts simply don’t know that they have access to better, healthier choices. 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 decision is an attempt to balance dollars and the negative effect of picking one over another.

“For 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 health care industry and community-based organizations can work together on addressing food insecurity through the lens of social determinants of health.

Informing Older Adults About MA Food Benefits

Some amount of food insecurity in the United States can be prevented through MA programs, especially as we enter 2022, with the growth of the meal benefit. There are approximately 5 million older adults nationwide, or three out of five older adults, who are 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 didn’t participate.

“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 advantage of the benefits they’re entitled to receive. By taking this small step, we can help lessen the negative impact of food insecurity on health outcomes.

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.