Supplemental Benefits Expansion & Unprecedented MA Growth

When Congress passed the CHRONIC (Creating High-Quality Results and Outcomes Necessary to Improve Chronic) Care Act in February 2018, it presented a significant shift in Medicare policy. Health plans were cautiously optimistic with the promised expansion of health-related supplemental benefits and the introduction of new categories of special supplemental benefits for the chronically ill (SSBCI).

Fast forward to 2021 and the number of operating Medicare Advantage (MA) plans has jumped to 4,800, an increase of 76.6% from 2017. Plans are now competing on a somewhat novel playing field that encourages innovative and evidence-based management of chronic conditions in older individuals, and the opportunity to drive performance based on cost management and improved health outcomes.

Meanwhile, more than 26 million Medicare beneficiaries were projected to enroll in a Medicare Advantage plan for 2021. These enrollees will benefit from the lowest average monthly premiums in 14 years, more plan choices, and enhanced services designed to meet the individualized needs of chronically ill beneficiaries, based on their values and preferences, within the goal of improving or maintaining health.

In September 2020, CMS highlighted expectations for these new categories of benefits that haven’t typically been covered in traditional Medicare:

• • • Telehealth—More than 94% of Medicare Advantage plans will offer additional telehealth benefits reaching 20.7 million beneficiaries, up from about 58% of plans offering telehealth benefits in 2020.
    • Palliative Care—53 Medicare Advantage plans will offer increased access to palliative care and integrated hospice care to their enrollees (through the Medicare Advantage Value-Based Insurance Design Model).
    • Primarily Health-related Benefits—Approximately 730 plans will provide about 3 million Medicare Advantage enrollees with additional types of supplemental benefits, such as adult day health services, caregiver support services, nutritional education, therapeutic massage or home-based palliative care. In 2020, 500 plans provided these services, an increase of 46%.
    • Access to Reduced Cost Sharing—Approximately 500 plans will offer up to 2.5 million Medicare Advantage enrollees with particular conditions, such as diabetes and congestive heart failure, with access to lower copayments or additional benefits such as meals and transportation.
    • Non-primarily Health-related Benefits—Approximately 920 plans will offer 4.3 million beneficiaries SSBCI benefits to help them better manage their chronic disease. This includes benefits such as home cleaning services, meal delivery, and transportation to the grocery store.
    • Medicare Advantage Value-based Insurance Design Model—More than 1.6 million beneficiaries are expected to receive additional benefits such as healthy foods and meals, transportation support, reduced cost-sharing and rewards and incentives aligned with Part D drugs. This is nearly 20 times the number of Medicare Advantage enrollees benefiting from the model in 2019.

Change is coming swiftly to MA health plans, and for the chronically ill beneficiaries who need additional support to stay in their home and out of the hospital.

To learn more about these supplemental benefits trends, register and attend our session: Trends to Consider for 2022 In Supplemental Benefits