June 12, 2019
In April 2018, the Centers for Medicare & Medicaid Services (CMS) issued rules allowing Medicare Advantage (MA) plans to extend coverage for a number of supplemental benefits for enrollees, but after a full year with the expansion, data shows only 20.8% of beneficiaries were enrolled in plans with any new benefits.
Research letter author David J Meyers, MPH, department of health services, policy, and practice, Brown University School of Public Health, Providence, RI, and colleagues used public data on 2019 MA plan benefits provided by CMS and analyzed which plans offered any of the various new supplemental benefits. These benefits include adult day care, home-based palliative care, in-home support, caregiver supports, memory fitness, and nonopioid pain management benefits.
MA enrolled 22 million individuals for coverage in 2019. The study examined 592 health plans comprising 4,542,775 MA beneficiaries, representing 20.8% of total MA beneficiaries.
"We were surprised to see that while 12.7% of plans offered a newly allowable supplemental benefit, the majority of these plans only offered caregiver supports," Kali Thomas, PhD, coauthor of the letter and associate professor of health services, policy and practice at Brown University's School of Public Health, said in an interview. "There was limited adoption of other benefits, such as in-home supports and adult day care, that directly focus on the social needs of members. This represents a noteworthy shift in MA benefit design as it not only addresses a 'non-medical need,' but it also extends it to a person who may not be a covered member."
Drs Meyers, Thomas and colleagues found that 24.9% of enrollees in health maintenance organization (HMO) plans had access to supplemental benefits in 2019, compared to the 14.4% of preferred provider organization (PPO) plan enrollees.
This research does not include data on supplemental benefits whose definitions were expanded to include coverage of additional services, such as CMS’ recent rule regarding coverage of transportation to and from medical facilities.
“Limited adoption may be attributable to plans’ risk aversion amidst changing regulations, a lack of evidence of new benefits’ profitability, or limited time to add new benefits between the regulation change announcement in April 2018 and the benefit proposal due date in June,” concluded Drs Meyers, Thomas, and colleagues.
Meyers DJ, Durfey SNM, Gadbois EA, Thomas KS. Early Adoption of New Supplemental Benefits by Medicare Advantage Plans. JAMA. 2019;321(22):2238–2240. doi:10.1001/jama.2019.4709