SummaryOver 3 million Medicare Advantage (MA) beneficiaries are enrolled in plans providing additional supplemental benefits to individuals with chronic illnesses, compared to just over 1 million in 2020.
New analysis of 2021 benefits and enrollment from Avalere finds that 787 MA plans offered by 44 parent organizations are providing special supplemental benefits for the chronically ill (SSBCI) in 2021. Those plans represent 16% of all analyzed MA plans. A majority (86%) of the total Medicare beneficiary population live in counties where at least 1 MA plan that offers at least 1 type of SSBCI is available. Overall, in 2021, 15% of enrollees in non-employer MA plans are enrolled in plans offering SSBCI, as compared to 6% in 2020.
Background on SSBCI
Supplemental benefits are additional services offered by MA plans that are not covered under Medicare Part A, Part B, or Part D. Until 2020, the Centers for Medicare & Medicaid Services (CMS) required that supplemental benefits be “primarily health-related,” meaning they needed to be intended to “diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization” (see Avalere’s analysis of primarily health-related supplemental benefit offerings for 2021, including vision, dental, and hearing benefits).
Starting in 2020, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2018 permits plans to also target non-primarily health-related supplemental benefits to beneficiaries with chronic illnesses (e.g., diabetes, asthma). By allowing SSBCI, policymakers gave MA plans more flexibility to address social and environmental factors that may impact beneficiary health.
2021 SSBCI Plan Offerings and Enrollment
In 2021, the second year that plans can offer SSBCI, 787 plans are offering at least 1 SSBCI, which is more than triple the number in 2020, when 239 plans offered these benefits. As shown in Table 1, among the plans offering SSBCI, the most commonly offered benefits are meals (45% of plans, enrolling 1.5 million beneficiaries), food and produce (43% of plans enrolling 1.9 million beneficiaries), and pest control (25% of plans enrolling 1.4 million beneficiaries). In addition, plans are offering new benefits in 2021, such as grocery and prescription delivery, that may be particularly important for enrollees who must stay home due to the COVID-19 pandemic. However, the number of plans offering these benefits—and associated enrollment—are relatively small compared to the most prevalent benefits.
|SSBCI Benefit Category||Plans Offering Benefit*||Percent of Plans Offering SSBCI Benefit Category||Percent of Enrollees in Plan Offering SSBCI Enrolled in Plan Offering Benefit Category|
|Meals (Beyond a Limited Basis)||356||45%||47%|
|Food and Produce||336||43%||60%|
|Social Needs Benefit||196||25%||28%|
|Transportation for Non-Medical Needs||167||21%||31%|
|General Supports for Living||142||18%||27%|
|Indoor Air Quality Equipment and Services||133||17%||23%|
|Services Supporting Self-Direction||89||11%||17%|
|Service Dog Support||79||10%||18%|
|Grocery Shopping and Door Drop||44||6%||3%|
|Prescription Pickup and Door Drop||44||6%||3%|
|Structural Home Modifications||42||5%||3%|
|Grocery Delivery Coverage||30||4%||0.8%|
|Pet Care Services||18||2%||1%|
|Independence and Safe Mobility with AAA||8||1%||0.2%|
|Thorough House Cleaning||7||1%||1%|
|Total Number of Plans Offering at Least 1 Category of Benefit**||787||100%||100%|
*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 one SSBCI are counted in multiple benefit categories.
As MA plans seek to address social risk factors, SSBCI can be an important tool for providing additional support for beneficiaries with chronic illnesses. Though only 16% of plans are offering SSBCI in 2021, the substantial increase from 2020 in the number of plans and enrollees in these plans indicates that plans are gaining more insight on the impact that SSBCI can have on beneficiary outcomes and costs. As plans test the impact of different benefits, new plans may decide to invest in providing SSBCI in future years. Stakeholders should consider engaging with the Biden administration around their early experiences with SSBCI and any policy change that could facilitate their wider adoption.
Avalere analyzed CMS’s Q2 2021 and 2020 Plan Benefit Package files and the January 2021 and January 2020 enrollment Public Use Files. The assessment of SSBCI reflects all non-employer waiver group plans with enrollment with at least 11 enrollees, regardless of a plan type, in all 50 states and the territories.
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