Real Medicare Advantage Innovation Starts with Connected Member Experiences

Connecting Care, Benefits, and Payments in Real Time

At the Medicare Market Innovations Forum in Charlotte, Lynx hosted a panel discussion titled, “Real Innovation in Medicare Advantage: Connecting Care, Payments, and Access.”

The conversation brought together leaders from Lynx, Signify Health, and CareCredit to discuss one of the most important challenges facing Medicare Advantage plans today: How to move beyond simply offering supplemental benefits and toward creating experiences members actually understand, trust, and use.

Across the discussion, one theme became clear:

Three themes shaped the conversation:

1. Moving from access to action
2. Using member experience as a retention strategy
3. Connecting care, payments, and benefits in real time

The Supplemental Benefit Gap: Access Does Not Guarantee Engagement

Medicare Advantage plans have invested heavily in supplemental benefits. Dental, vision, hearing, OTC, transportation, food, in-home support, fitness, and other benefits have become central to how plans compete, differentiate, and support members. But adding more benefits does not automatically create engagement, trust, or utilization.

The Commonwealth Fund found that nine out of 10 Medicare Advantage beneficiaries said supplemental benefits are important, yet only seven out of 10 said they used them. That gap highlights the core challenge for plans: A benefit only creates value when a member knows it exists, understands how to use it, trusts the experience, and can act at the right moment.

For health plans, the next phase of supplemental benefit strategy is not just about offering more. It is about helping members activate what is already available to them.

Turning Supplemental Benefits Into Real Member Action

A recurring message from the panel was that the member journey often breaks down between benefit design and benefit activation. Jill Suranie of Signify Health emphasized the importance of trust, especially when engaging members in their homes.

Signify Health’s in-home model gives plans a way to see beyond claims data and better understand the member’s lived experience. Its in-home evaluations are clinician-led visits that assess physical, behavioral, and social care needs, including medication review, diagnostic services, and social determinants of health screening.

That matters because many barriers to engagement have little to do with whether a benefit technically exists. Members may face transportation issues, mobility limitations, food insecurity, limited digital literacy, cost concerns, or confusion about where to go next.

In fact, Healthy People 2030 notes that social determinants of health significantly affect health and quality of life as people age, and that about eight in 10 older adults struggle to use medical documents such as forms or charts. In other words, members may not need more benefits as much as they need a clearer path to action.

For Matt Muscolo of CareCredit, the access-to-action gap is especially visible in dental care, where cost uncertainty can delay treatment.

CareCredit research found that 58% of respondents view dental care as unaffordable, and 83% would consider delaying emergency dental care due to cost. For Medicare Advantage plans, that creates a meaningful challenge. Dental benefits may be available, but if the member does not understand coverage, cost, financing, or payment options at the point of care, the benefit may never translate into treatment.

Candace Sjogren of Lynx tied the issue back to infrastructure.

The takeaway was clear: Benefit activation requires infrastructure that connects eligibility, funding, engagement, payments, and provider workflows into a seamless, real-time member experience.

Member Retention Depends on Experience, Not Just Benefit Design

The panel also explored whether health plans may be overestimating benefits alone as a retention tool. Supplemental benefits can influence enrollment and satisfaction, but retention depends on whether members feel supported over time. A benefit that is difficult to understand, hard to use, or disconnected from the care journey may not create lasting loyalty.

The broader market is starting to recognize a major shift: Medicare Advantage plans are no longer competing only on benefit design. They are competing on whether members can experience the value of those benefits in real life.

Matt Muscolo added that value also comes from utility and reuse. CareCredit is not tied to a single plan year or payer relationship. Its value grows when members can use it across more moments of care.

For Lynx, the opportunity is helping plans turn benefits into experiences members can actually see, understand, and use. This is especially important as plans rethink digital engagement.

Medicare Advantage members may be older, but that does not mean they are uninterested in technology. They want simple, trusted, accessible tools that help them understand what they have, what they can use, and what action to take next.

Fragmentation Is the Hidden Problem in Medicare Advantage

One of the clearest themes from the panel was fragmentation across the member experience. Care, benefits, rewards, payments, financing, and provider workflows often live in separate systems.

That fragmentation creates problems for everyone in the ecosystem:

• For members: Confusion about what is available and how to use it
• For providers: More administrative friction at the point of care
• For plans: Lower utilization, limited visibility, and missed opportunities to improve outcomes

Candace Sjogren described the opportunity as creating a more unified system where members can understand, activate, and use their benefits. This is where financial infrastructure becomes central to member experience.

Members may have plan dollars, rewards, supplemental benefits, HSA or FSA funds, manufacturer support, financing options, or other resources available. But if those resources cannot come together at the moment of care or purchase, the member experience remains fragmented.

In dental, Matt Muscolo explained that the goal is to give both members and providers more clarity upfront.

That clarity matters to providers as well. When provider staff can explain coverage and payment options confidently, the member is more likely to move forward with care. When the financial picture is unclear, uncertainty transfers directly to the patient.

That is the heart of the Medicare Advantage innovation opportunity. Health plans do not need more disconnected tools or isolated point solutions. They need connected systems that translate care insights into benefit access, and benefit access into action.

Why Health Plans Are Rethinking Member Experience Infrastructure

CMS’s 2026 Medicare Advantage and Part D final rule continues to emphasize beneficiary protections, plan transparency, and operational improvements across Medicare Advantage and Part D. That reinforces the need for plans to deliver benefits in ways that are understandable, usable, and accountable.

CMS guidance is reinforcing what many plans are already experiencing firsthand: Health plans need more visibility into whether benefits are being used, how members are engaging, and where the experience breaks down.

For Medicare Advantage plans, the next phase of innovation will likely require:

• Clearer benefit activation pathways
• Stronger member education and trust-building
• More connected partner ecosystems
• Point-of-care payment and coverage transparency
• Better utilization data and reporting
• Infrastructure that supports real-time eligibility, funding, and payment logic

The best supplemental benefit strategy is not simply one that looks compelling during enrollment. It is one that works when a member is trying to buy OTC items, schedule an in-home visit, access dental care, complete a rewardable activity, or understand how to pay for care. That requires a seamless, unified, transparent experience from education to activation to payment.

The Future of Medicare Advantage Will Be Defined by Experience

The strongest takeaway from the panel was this: real innovation in Medicare Advantage is not just adding more benefits. It is connecting the experience around the member.

That means connecting:

• Care delivery
• Benefit access
• Rewards and incentives
• Provider workflows
• Payment options
• Utilization data
• Reporting infrastructure

As Medicare Advantage plans continue to navigate member expectations, cost pressure, supplemental benefit utilization, and retention, the ability to connect these pieces will become increasingly important.

The future of Medicare Advantage will not be defined solely by the number of benefits plans offer. It will be defined by how seamlessly members can understand, access, trust, and use those benefits in the moments that matter most.