Medicare Advantage plans see barriers to non-medical benefits

Ron Shinkman Sept. 19, 2019

Dive Brief:

• The Centers for Medicare and Medicaid Services allowed Medicare Advantage plans to use cost control rebates for non-medical enrollee benefits. Although the average rebate is $107 per member per month, a new Robert Wood Johnson and Urban Institute report suggests there may be some barriers in pushing new benefits out to beneficiaries.  
• The biggest obstacle is the rebates are already being applied to previously allowable expenditures, such as for dental coverage or other medically-related benefits.
• However, some MA insurers say they're expanding coverage for meals, adult day care and other services.

Dive Insight:

About 22 million seniors and disabled are enrolled in MA health plans, making them one of the most important components of Medicare. What makes them particularly attractive is they often offer beneficiaries more benefits than if they remain enrolled in traditional Medicare.

A variety of recent studies suggest seniors' health would improve if they received ancillary, non-clinical services such as supplementary meals, adult day care, or services that would help them avoid falling at home. To address these needs, CMS this year loosened the rules regarding what MA plans could use "rebates" — money they saved on care for beneficiaries. In some states, the rebates are considerable: more than $300 per beneficiary per month enrolled in special needs MA plans in Nevada, and more than $200 per month in Florida. Both of those states have large retiree communities.

The new study by the Urban Institute and the Robert Wood Johnson Foundation included interviews with five MA insurers representing about 38% of the nationwide market. The interviews took place before the carriers had to roll out their benefits for the 2019 plan year.

However, most confirmed they were adding some non-healthcare benefits, although generally they were fairly limited in scope, primarily because there is no new funding attached to the expansion of benefits.

Three plans said they offered expanded meal service and one relaxed rules tying such meals to a recent hospital discharge. Two began offering an adult day care benefit, hoping to reduce the relative social isolation of beneficiaries. However, one plan is offering coverage for just one day a week while another is just offering credits toward a day care visit.

Two insurers are also offering coverage for improving the safety in the homes of beneficiaries and another is offering a $500 credit toward purchasing in-home assistive devices. Two carriers are also offering personal in-home helpers but for limited durations of time.

Some of the insurers urged CMS relax the rules further — particularly one where the new benefits still have to have some sort of direct connection to the beneficiary’s medical condition.

"If you really want to be impactful, then you should let your plans use these (benefits) and target these not based on the fact that somebody has diabetes or congestive heart failure, but rather that maybe they’re a frequent flyer at the (hospital emergency department)," one interviewee said.

https://www.healthcaredive.com/news/medicare-advantage-plans-see-barriers-to-non-medical-benefits/563360/