Medicare Advantage Plans Pulling Back On In-Home Care Supplemental Benefits

Insurance companies selling Medicare Advantage (MA) plans have been facing increased scrutiny from members of Congress and regulators, with critics of the private version of Medicare claiming carriers are profiting far too much.

In light of those sentiments and expected constraints, some believed MA plans could begin trimming their supplemental-benefits packages, which could lead to fewer home-based care offerings delivered under the Expanded Primarily Health-Related Benefits (EPHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI) options.

MA plans began touting their benefits to Medicare beneficiaries at the beginning of October – and early signs suggest a pullback is, indeed, taking place.


“Fewer plans are using SSBCI to offer benefits, with decreases in Social Needs Benefits (128 fewer plans than in 2023) and Meals (99 fewer plans),” Washington, D.C.-based research and advisory firm ATI Advisory wrote in a LinkedIn post.

Specifically, across EPHRB, SSBCI and VBID authorities in 2024, 867 plans will offer in-home support services (IHSS) as a supplemental benefit, according to ATI. This is a decrease from the 1,308 plans offering this benefit in 2023.

It’s not exclusively due to the brighter spotlight on plans, however.


“We suspect the main reason behind the decrease is that IHSS is a more administratively complex benefit to offer, especially compared to something like a grocery card,” Bill Winfrey, director of Medicare innovation at ATI Advisory, told Home Health Care News in an email. “To offer the benefit, plans must identify providers in a crowded marketplace, build a provider network to ensure market coverage and manage increasing labor costs that are driving up the cost of the benefit itself.”

Before heading into the 2024 plan year, IHSS had been one of the most popular benefits. There was a 364% increase in plans offering the benefit since 2020.

Dr. Sachin Jain, CEO of the Medicare Advantage organization The SCAN Group, recently discussed how MA plans may operate in this different environment with HHCN sister publication Palliative Care News.

“The way Medicare Advantage works is that we receive a risk adjusted, per member, per month payment in addition to revenue bonuses for [star ratings], which then fuels our ability to purchase services on behalf of our members,” Jain told Palliative Care News. “It just goes to reason that if we start getting paid less in aggregate, then our downstream entities are likely going to either see smaller increases or lower payments.”

CMS moved forward with changes to its risk-adjustment process earlier this year via its 2024 final rule for Medicare Advantage plans. The agency is implementing a 3.3% base-rate increase for MA plans while beginning a three-year phase-in of an updated approach to risk adjustment.

On top of that, the agency is transitioning its code system from Internal Classification of Diseases (ICD)-9 to ICD-19. It removed more than 2,000 of the diagnosis codes that MA plans use, with the affected codes “focused on conditions that are subject to more coding variation,” according to CMS.

“Paying Medicare Advantage plans more accurately for the care they provide is how we ensure that people enrolled in Medicare Advantage, especially populations with the highest health disparities and people in underserved communities, can continue to access the care they deserve,” CMS Administrator Chiquita Brooks-LaSure said in a statement.

An HHCN review of benefit announcements from some of the largest insurers reinforces the notion that fewer are touting home-based care offerings for 2024.

In recent years, many highlighted benefits for a certain number of hours of in-home support from in-home care technicians who can assist with light housekeeping and activities of daily living (ADLs). In-home companionship services and programs designed to ensure smooth hospital-to-home transitions were also common.

Few of the big insurers are touting the same degree of home-based care benefits for 2024 in their announcements.

Elevance Health (NYSE: ELV) highlighted supplemental benefits such as “dental, vision and hearing, transportation to medical appointments, assistive devices, utilities such as gas and electric bills, and groceries,” for example. UnitedHealthcare touted similar benefits, plus home delivery prescriptions.

Aetna – whose parent company, CVS Health (NYSE: CVS), acquired both Oak Street health and Signify Health – will offer an annual “healthy home visit” to members and access to primary care clinics.

Oak Street Health’s innovative care model provides comprehensive primary care with a focus on prevention and wellness. Aetna MA members will have access to all Oak Street Health primary care clinic locations across the country as part of the extensive Aetna provider network.

“[A health home visit] includes a comprehensive health risk assessment and non-invasive physical exam from the comfort of the member’s home,” Aetna wrote in an announcement. “The clinician will also evaluate the home environment to identify social support needs and risks that could result in early detection of health problems.”

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