The ability to offer non-medical benefits to both improve quality and cost-effectiveness for Medicare Advantage (MA) plan enrollees is significant, especially in a post-COVID era where Social Determinants of Health (SDOH) present major barriers to health and well-being. MA plans are likely – but not certain to – offer more health-related and SDOH-related benefits in the coming years.
MA plans are the most rapidly growing private plan option under Medicare. More than one-third of all Medicare beneficiaries choose MA plans, which in 2020 represented more than 24 million people nationwide. The program has grown nearly 10 percent year over year, and the Centers for Medicare and Medicaid Services (CMS) expects enrollment to top 30 million in the next few years. While all MA plans must provide services covered by Medicare Part A and Part B, MA plans can offer these services at a lower cost than Original FFS Medicare. The federal government uses these cost savings to purchase supplemental benefits for beneficiaries.
Before the Chronic Care Act, MA plans could only offer primarily health-related supplemental benefits, such as dental care, and had to make them available to all plan enrollees. Through the Chronic Care Act, beginning in 2020, MA plans could also offer Special Supplemental Benefits for the Chronically Ill (SSBCI). These benefits may include services that are not primarily health-related, such as home care, as long as the service has a reasonable expectation of improving or maintaining the chronically ill enrollee’s health or overall function. The new law also gives the United States Secretary of Health and Human Services the authority to waive, only for SSBCI, the requirement that benefits be made available to all MA plan enrollees.
Plans that offered primarily health-related benefits increased significantly between 2018 and 2020 including services such as meals, transportation, in-home support services and acupuncture. In 2020 only 6% of MA plans offered (SSBCI).
MA plans have struggled with COVID-related challenges as well as operational and logistical challenges which may have prevented greater use of SSBCI non-medical benefits. Plans should explore the opportunity to offer additional supplemental benefits, especially where these services can result in improved quality and cost-effectiveness of care.