- A minority of Medicare Advantage plans have added benefits targeted at enrollees with serious chronic illnesses. In 2019, 507 MA plans, or 11% of the total number of plans, offered supplemental benefits. Fewer plans — 377, or 7% — will offer supplemental benefits in 2020, but the reduction is based largely on the actions of one national payer, according to a new study from the Duke Margolis Center for Health Policy.
- The benefits for seriously ill enrollees include: adult daycare (63 plans in 2020), palliative care (23 plans in 2019 and 58 in 2020), non-opioid pain management (24 plans in 2019 and 201 plans in 2020), in-home support services (71 plans in 2019 and 148 in 2020), and caregiver support (389 plans in 2019 and 82 plans in 2020).
- These supplemental benefits for seriously ill enrollees are more likely to be available in urban areas than rural areas or in areas with higher concentrations of Medicare-eligible seniors who are enrolled in MA plans, the study found.
Medicare Advantage plans are popular with payers and beneficiaries. A total of 3,148 MA plans will be available across the country in 2020 — or 414 more plans than in 2019, according to the Kaiser Family Foundation’s Medicare Advantage 2020 Spotlight: First Look. The foundation expects those plans to enroll a third of all Medicare-eligible seniors, or more than 22 million people, in 2020.
MA plans are popular because they offer more types of benefits than traditional Medicare, such as coverage for vision care, dental services, hearing aids and medications.
But beginning in 2019, CMS gave MA plans the flexibility to offer even more benefits, including nonmedical services, to help their members with chronic illnesses maintain their health and ability to live independently.
Some of those options include home-based palliative care, adult day care services, in-home support, personal care services, caregiver support services, medically-approved non-opioid pain management, a memory fitness benefit, and home and bathroom safety devices and modifications, according to the Duke study.
In 2020, CMS identified additional benefits that MA plans could offer enrollees with serious chronic illnesses, which the agency specified as diabetes, dementia, heart failure, and stroke. The additional benefits include food, pest control, indoor air quality equipment, and structural home modifications, according to the Duke Margolis Center.
Researchers at Duke analyzed longitudinal and supplemental benefit data published by CMS. They also interviewed key leaders at health plans in June and July of 2019. They focused their analysis only on benefits that would be targeted at seriously ill beneficiaries.
Interviewees described barriers to implementing the supplemental benefits for enrollees with chronic illnesses, according to the study.
One issue is money. CMS did not provide new funding to pay for the supplemental benefits, making it challenging for the insurers to offer more than a few new benefits.
Another issue is the administrative complexity and cost involved in contracting with local organizations that provide social services such as adult daycare or in-home support services. These organizations may lack the technical sophistication to manage protected health information or carry liability insurance that meets insurers’ rules. As one interviewee told the researchers, “It’s a lot of work to teach organizations how to contract with a health plan.”
There’s also a lack of evidence about how enrollees will use the new benefits, if the benefits will lead to cost savings in future years, or attract different members, potentially altering a plan’s risk pool.