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New Study Details Medicare Advantage Plans Offering Newly Authorized Supplemental Benefits

More than 100 Medicare Advantage plans will offer new "health-related" supplemental benefits in 2019, according to a report commissioned by the Better Medicare Alliance and conducted by Milliman. In April, the Centers for Medicare and Medicaid Services (CMS) expanded the scope of authorized "primarily health-related" supplemental benefits to allow plans to offer benefits that are used not only to diagnose, prevent, or treat an illness or injury, but also to compensate for physical impairments, ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization.

The Better Medicare Alliance report identifies the plans that are offering new benefits, such as in-home supports (typically personal care), home-based palliative care, memory fitness, and medically approved non-opioid pain management. It also lists the states in which those plans are offering the benefits. The report does not include expansions of benefits that were previously authorized, such as home safety devices and modifications, transportation, and over-the-counter (OTC) pharmacy. Nor does it identify the more than 400 plans that are now offering caregiver supports, such as personal care and respite, because they may represent reclassifications of previously authorized benefits. Notably, the report suggests that no plan has contracted for adult day health care, but other studies have concluded that a small number of plans are offering adult day health care as a supplemental benefit. The basis for this discrepancy is unclear; however, the authors note that they have made certain assumptions that, if altered, would drive different results.

In New York State, the report indicates that Well Care's Medicare Advantage plans are offering in-home supports (e.g., personal care), and several Fully Integrated Duals Advantage (FIDA) plans are offering home-based palliative care. The rollout of the new benefits has been relatively slow because authority to offer the new benefits was finalized shortly before the deadline for the submission of 2019 plan benefit packages to CMS. Medicare Advantage plans may seek to expand their supplemental benefit offerings when they submit their 2020 benefit packages to CMS in mid-2019. The expansion of these benefits may present opportunities for home and community-based services (HCBS) providers to contract with Medicare Advantage plans.

More information about these benefits is available here, here, and here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124