Enrollment in MA Plans with SSBCI Nearly Quadrupled Since 2020

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Summary

In 2022, nearly 4.5 million beneficiaries are in Medicare Advantage (MA) plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI), compared to 1.2 million in 2020, the first year these benefits were available.

Over the same period, the number of plans offering at least 1 type of SSBCI increased from 6% to 23%.  In 2022, the most commonly offered SSBCI benefits are food and produce, meals, and transportation for non-medical needs.

Background on SSBCI

Supplemental benefits are services offered by MA plans that are not covered under Medicare Parts A, B, or D. Until 2020, the Centers for Medicare & Medicaid Services (CMS) required that supplemental benefits be “primarily health-related,” meaning they must be used to “diagnose, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduces avoidable emergency and healthcare utilization.” Prior Avalere analyses assessed plan offerings of primarily health-related benefits, finding that plans expanded supplemental benefit offerings from 2018 to 2021.

Beginning in 2020, plans could also provide a broader array of benefits—SSBCI—to enrollees with chronic illnesses. The purpose of these benefits is to help plans manage patients’ chronic illness and slow disease progression by addressing a variety of social risk factors, such as lack of access to transportation, limited access to healthy foods, or consistent exposure to poor air quality. By improving patient healthcare outcomes, MA plans may reduce spending and improve quality measure performance.

2022 SSBCI Plan Offerings and Enrollment

In 2022, the third year that plans can offer SSBCI, 19% of MA enrollees are enrolled in plans that are offering at least 1 SSBCI, compared to 6% of enrollees in 2020. As shown in Table 1, among the plans offering SSBCI, the most commonly offered benefits are food and produce (16% of plans, enrolling 3.39 million beneficiaries), meals (8% of plans, 2.24 million beneficiaries), and transportation for non-medical needs (8% of plans, 2.15 million beneficiaries). Indoor air quality equipment and services, data plans, and services supporting self-direction saw the greatest increase in the percentage of plans offering the benefit from 2020 to 2022.

In addition, plans are offering new benefits in 2022, such as complementary therapy, housekeeping, identity theft insurance, memory support kits, travel care assistance, and utilities cards. While relatively few plans are offering these new benefits in 2022, the introduction of new types of benefits demonstrates a growing interest among MA plans to engage with a wider array of non-medical services and products.

Table 1: Special Supplemental Benefit for the Chronically Ill Offerings, 2020–2022
SSBCI Benefit Category Number of Plans Offering SSBCI Benefit Category Number of Enrollees in Plans Offering SSBCI (in Thousands)
2020 2021 2022 2020 2021 2022
Plans with at Least 1 SSBCI Offering (Percentage of All Plans) 239 (6%) 793 (17%) 1,172 (23%) 1,199 3,234 4,463
Food and Produce 99 337 817 710 1,934 3,392
Meals 71 361 426 278 1,518 2,242
Transportation for Non-Medical Needs 84 168 400 375 991 2,151
Pest Control 118 201 348 645 1,454 2,054
General Supports for Living 67 143 322 291 865 1,539
Social Needs Benefit 32 200 257 152 900 788
Indoor Air Quality Equipment and Services 52 134 156 251 739 892
Pet Care Services 18 149 46 975
Services Supporting Self-Direction 20 90 139 115 554 796
Complementary Therapy 1 113 37 710
Travel Care Assistance 113 710
Service Dog Support 51 79 63 456 598 634
Structural Home Modifications 44 42 81 90 92 404
Prescription Pickup and Door Drop 46 44 110 123
Virtual Visit 46 44 110 123

*Plan is defined as a unique Contract ID-Plan ID-Segment ID combination. Only non-employer group waiver plans were identified in the analysis as offering SSBCI.

**Plans that offer more than 1 SSBCI are counted in multiple benefit categories.

Looking Ahead

The 4-fold increase in MA plans offering at least 1 SSBCI between 2020 and 2022 suggests that plans may be gaining more insight on the impact that SSBCI can have on health outcomes, costs, and attracting members. Plans offered 7 new SSBCI in 2022, and will likely consider offering additional types of SSBCI in the future.

Given the increased MA plan enrollee access to SSBCI, policymakers may consider mechanisms to collect additional data on supplemental benefits. For example, the CMS is proposing to require plans to submit the cost of providing SSBCI as part of medical loss ratio reporting in the CY 2023 Medicare Advantage and Part D Proposed Rule. This information could inform policymakers’ thinking around future policy changes that could either expand or restrict the types of SSBCI that can be offered and to which patients.

As SSBCI become more widespread, MA plans should also consider how utilization of specific SSBCIs affect plan costs and beneficiary utilization (i.e., hospitalizations). Plans may also want to understand how SSBCIs can be used as a strategy to attract and retain enrollees and how offering SSBCI could address health disparities and advance health equity.

As plans typically offer supplemental benefits through partnerships with a variety of vendors, organizations that offer relevant services and products should consider how to effectively measure and articulate their benefit offerings to align with supplemental benefit requirements and how to engage plans on novel benefit offerings.

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Methodology

Avalere analyzed CMS’s Q2 2022, 2021, and 2020 Plan Benefit Package files and the February MA enrollment Public Use Files. The assessment of SSBCI reflects all non-employer waiver group plans with enrollment of least 11, regardless of a plan type, in all 50 states and the territories.

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