November 19, 2019
Summary
Medicare Advantage (MA) plans continue expanding coverage of
supplemental benefits following administration’s policy changes from a year
ago.
New analysis from Avalere finds that MA plans will continue to increase their
supplemental benefit offerings in 2020, following increased flexibility
provided by the Centers for Medicare & Medicaid Services (CMS) for the 2019
plan year. Supplemental benefits are additional
services offered by MA plans that are not covered under Medicare Part A, Part
B, or Part D, including transportation to physician visits, coverage of OTC
drugs, meals, and other supplemental services that promote beneficiary health
and wellness.
The key
supplemental benefits that have been increasingly offered by plans from 2018 to
2020 include meals, transportation, acupuncture, and over-the-counter (OTC)
benefits, among others (Table 1).
|
Number (Percent) of MA
Plans Offering Benefit
|
|||
|
Most Prevalent
Supplemental Benefits
|
2018
|
2019
|
2020
|
|
Acupuncture
|
11%
|
16%
|
20%
|
|
Dental
|
79%
|
84%
|
87%
|
|
Fitness
|
93%
|
95%
|
95%
|
|
Hearing
|
83%
|
90%
|
93%
|
|
Home Modifications
|
6%
|
7%
|
10%
|
|
In-Home Support
Services
|
8%
|
15%
|
16%
|
|
Meals
|
20%
|
39%
|
46%
|
|
Nutrition/Wellness
|
16%
|
16%
|
17%
|
|
OTC Benefit
|
42%
|
58%
|
68%
|
|
Telehealth
|
7%
|
6%
|
59%
|
|
Transportation
|
19%
|
28%
|
35%
|
|
Vision
|
95%
|
98%
|
98%
|
|
Table 1. Supplemental
Benefit Offerings in 2018, 2019, and 2020
|
|||
The big 3 supplemental benefits (vision, hearing, and dental)
are now almost universally available (98%, 93%, and 87%). The notable increase
in telehealth is associated with the change
in the data reporting structure, which in 2020 allows plans to specifically
indicate that they provide telehealth as a supplemental benefit. In addition,
plans were able for 2020 to include additional telehealth services as basic
Medicare benefit in their Part A and Part B bid submissions to CMS in order for
them to be paid for by Medicare. This change may have led plans to report
telehealth as a supplemental benefit because the reporting tool does not yet
allow plans to report it as a basic benefit.
In addition, 2020 is the first year when MA plans are allowed to
offer non-primarily health-related special supplemental benefits for the
chronically ill (SSBCI) such as food and produce, home-delivered meals (beyond
a limited basis), pest control, and transportation for non-medical needs.
However, the information on those benefits has not been released yet by CMS.
“While we now have insight into the majority of supplemental
benefit offerings in 2020, we are still waiting for CMS to release data on
SSBCI benefits that will be targeted at specific populations,” said Joanna
Young, associate principal at Avalere. “More importantly, these are the
non-primarily health-related benefits that will allow plans to start to address
social determinants of health, and we are very interested in seeing what plans
are going to do.”
Methodology
Avalere analyzed MA plan benefits data in the Q1 2020, Q4 2019,
and Q4 2018 plan benefit package (PBP) files released
by CMS. Due to different naming conventions that plans use to describe their
supplemental benefits—primarily those not associated with specific
rubric/category in the PBP file structure—our counts might be underestimating
the actual availability of specific supplemental offerings. Avalere excluded MA
plans with no drug coverage, Employer Group Waiver Plans, Cost, PACE and Demo
plans from the analysis. The analysis includes MA plans in the 50 states, DC,
and the territories.
To receive Avalere updates, connect with us.
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