New CMS Data Highlights ‘Massive’ Expansion of Home Care-Related Medicare Advantage Benefits

The U.S. Centers for Medicare & Medicaid Services released a treasure trove of new Medicare Advantage (MA) statistics late Thursday.

While the new numbers flag a general rise in MA enrollment and drop in premiums, they also reveal a massive expansion of the supplemental benefit programs that have gotten home care operators so excited over the past few years.

“The increase in the number of plans that are offering these additional types of supplemental benefits is exciting,” ATI Advisory CEO Anne Tumlinson told Home Health Care News. “It’s creating a really good marketplace for beneficiaries. Not only are their prices for enrolling lower than they have been in the past, but the number of new and innovative types of benefits — and plans offering them — is higher.”

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ATI Advisory is a Washington, D.C.-based research and advisory services firm.

Prior to 2019, non-medical home care agencies did not have a role in the Medicare Advantage landscape. After a variety of policy chances, they now have an opportunity to contract with MA plans through two major pathways.

The first is the “primarily health related” pathway, which CMS carved out in 2018 rulemaking. The second is the broader “Special Supplemental Benefits for the Chronically Ill,” or SSBCI, pathway created a year later.

According to Thursday’s CMS statistics, there will be 730 MA plans offering expanded, primarily health related supplemental benefits in 2021. That figure is a 46% increase from the 500 MA plans to do so in 2020.

“We think that’s mainly describing five benefits, with in-home supportive services being one of the most popular of those five benefits,” Tyler Cromer, a principal at ATI Advisory, told HHCN. “It’s in-home supportive services, support for caregivers, home-based palliative care, adult day and therapeutic massage.”

Meanwhile, 920 plans — reaching 4.3 million beneficiaries — will be offering the SSBCI benefits in 2021, a nearly four-fold increase compared to the 245 plans to do so this year. SSBCI includes in-home supportive services, but also benefits like transportation help, nutrition assistance and more — anything that helps chronically ill individuals stay in their home and out of the hospital.

“Looking back, 2020 was the first year these benefits could be offered,” Cromer said. “We definitely expected growth in 2021, but this is so exciting. This is showing us that plans are really interested in providing benefits that help individuals with chronic illness.”

At this point, it’s unclear just how many of the MA plans operating in either the primarily health related pathway or under SSBCI are specifically offering in-home care in 2021. That information should become available in October, Tumlinson noted.

What is clear based on Thursday’s MA statistics from CMS, however, is that the U.S. has hit a turning point when it comes to Medicare Advantage and what plans strategically offer.

Overall, 26 million people — or about 42% of all Medicare beneficiaries — are projected to enroll in an MA plan for 2021.

“The fairly significant increase in the number of plans that are offering these benefit signals, to us, that these are here to stay,” Tumlinson said. “This is not a flash in the pan. This is not a fluke. This is now a real, concrete part of the Medicare Advantage program, from this point forward.”

Apart from statistics on supplemental benefits related to in-home care in 2021, CMS also shared its latest figures on the hospice carve-in under Medicare Advantage. For the first time in Medicare history, 53 MA plans next year will offer increased access to palliative care and integrated hospice care to their enrollees through the Medicare Advantage Value-Based Insurance Design (VBID) Model.

In conversations leading up to a hospice carve-in, some end-of-life care providers expressed concern about diluting the traditional hospice benefit and having to negotiate rates with MA plans. Tumlinson noted that 2021 VBID participation will help to test those concerns and gauge the effectiveness of a hospice carve-in.

“This is not a ton of plans, in the big scheme of things,” she pointed out. “This is kind of a ‘right number’ of plans. It’s going to allow CMS to really learn how it’s going to work in a controlled kind of a way.” 

CMS has made Medicare Advantage a priority under the Trump administration, with the president even calling for Medicare-MA parity in an October 2019 executive order. The latest numbers on MA enrollment and plans participating in innovative supplemental benefit programs reflect that push, according to CMS Administrator Seema Verma.

“Historically low premiums, massive savings on insulin and more supplemental benefits represent the welcome fruit of the creative, patient-oriented policies that this administration has made its calling card,” Verma said in a statement. “Medicare beneficiaries will feel the difference – in their health as well as their pocketbook.”

The number of MA plans has grown to 4,800 health plans available during the 2021 open enrollment season, a 76.6% increase since 2017.

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