Whether Medicare Advantage enrollees are dually Medicaid-Medicare eligible or not, health-related social needs are largely prevalent, a new study shows.

The July study was published in Health Affairs and was conducted by researchers at Humana and Blue Cross Blue Shield of Massachusetts. It examined the prevalence of health-related social needs in 2019 among beneficiaries enrolled in individual Medicare Advantage plans offered by Humana, the second largest MA payer in the U.S. The research sample included 11,896 dual-eligible enrollees and 49,883 non-dual-eligible enrollees. 

The study focused on seven health-related social needs: financial strain, food insecurity, poor housing quality, utility insecurity, unreliable transportation, loneliness or social isolation and housing insecurity.

It found that 80% of dual-eligible beneficiaries had at least one health-related social need in 2019, compared to 48% of non-dual-eligible enrollees. The dual-eligible group had 2.2 health-related social needs on average, versus 0.9 for the non-dual-eligible group.

Financial strain was the most prevalent social need for both populations: 65% of dual-eligible beneficiaries and 32% of non-dual-eligible beneficiaries. Loneliness and housing insecurity tied for the least common for both groups: 14% of dual-eligible beneficiaries and 6% of non-dual-eligible enrollees.

While dual-eligible beneficiaries had more health-related social needs, non-dual-eligible beneficiaries still had a significant amount, showing the need to screen both populations for these needs.

“Using dual-eligibility status alone as a proxy or targeting mechanism to avoid screening all beneficiaries for [health-related social needs] would have missed many MA beneficiaries with [health-related social needs],” the report stated.

The study also found that beneficiaries aged 65 and older were less likely than younger beneficiaries — who qualify based on a disability — to have a health-related social need. Dual-eligible beneficiaries aged 65 to 69 years were 40% less likely to have a social need than younger groups. Non-dual-eligible beneficiaries aged 65 to 69 years were 65% less likely to have a social need than younger groups.

“Our findings suggest the importance of considering the needs of both dual- and non-dual-eligible beneficiaries, and of beneficiaries of all ages, when exploring how to address [health-related social needs] in the MA population,” the researchers said.

There were also differences based on race, the report found. For example, Black dual-eligible beneficiaries were 26% more likely to face food insecurity than White dual-eligible beneficiaries, and Black non-dual-eligible beneficiaries were twice as likely to face food insecurity than White non-dual-eligible beneficiaries. 

There were several questions left unanswered, however, the researchers stated. There needs to be more research on the prevalence of health-related social needs on other Medicare Advantage populations, how the prevalence changes over time, what interventions are successful, what the cost benefits are and what health stakeholders are best situated to address health-related social needs.

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