SummaryMedicare Advantage (MA) plans are using new flexibilities to provide additional supplemental benefits to beneficiaries with chronic illnesses.
New analysis from Avalere finds that in 2020 239 MA plans offered by 23 parent organizations are providing special supplemental benefits for the chronically ill (SSBCI). Those plans represent 6% of all non-employer group waiver plans (EGWPs). More than half (56%) of the total Medicare beneficiary population lives in counties with at least 1 MA plan that offers at least 1 type of 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 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 2020, including vision, dental, and hearing benefits).
Starting in 2020, the CHRONIC Care Act of 2018 permits plans to also target non-primarily health-related supplemental benefits to beneficiaries with chronic illnesses. By allowing SSBCI, policymakers are giving MA plans more flexibility to address social and environmental factors that may impact beneficiary health.
2020 SSBCI Plan Offerings
Among the plans offering SSBCI, the most commonly offered benefits are pest control (49% of plans), food and produce (41%), and transportation for non-medical needs (35%). While plans may choose to offer SSBCI other than the 10 benefits specifically outlined by CMS (see Table 1), few plans are doing so in 2020. The only SSBCI outside of these specified categories is a service dog support benefit, offered by 51 plans from the same parent organization.
|SSBCI Benefit Category||Plans Offering Benefit*||Percent of Plans Providing SSBCI Offering Benefit Category|
|Total Number of Plans||Total Number of Non-SNPs||Total Number of SNPs|
|Food and Produce||99||62||37||41%|
|Transportation for Non-Medical Needs||84||58||26||35%|
|Meals (Beyond Limited Basis)||71||40||31||30%|
|Indoor Air Quality Equipment and Services||52||50||2||22%|
|Structural Home Modifications||44||43||1||18%|
|Social Needs Benefit||32||21||11||13%|
|Services Supporting Self-Direction||20||16||4||8%|
|Total Number of Plans Offering at Least 1 Category of Benefit**||239||155||84||100%|
*Note: Plan is defined as a unique Contract ID-Plan ID-Segment ID combination. Only non-EGWP plans were identified in the analysis as offering SSBCI.
**Note: Plans that offer more than 1 SSBCI are counted in multiple benefit categories
Enrollment in Plans Offering SSBCI
While only a relatively small percent of plans are offering SSBCI for 2020, more may consider providing these services in future years as they gain more insight into the impact on beneficiary health outcomes, cost, and plan selection. Notably, 11% of special needs plan (SNP) enrollees—compared to 5% of non-SNP enrollees—are in plans that offer SSBCI (not including beneficiaries enrolled in EGWPs). As plans gain more experience with these benefits, those with a higher proportion of chronically ill beneficiaries may be faster to adopt these new benefits as a strategy to better manage care and impact social determinants of health.
CMS Proposes to Expand Eligibility for SSBCI for 2021
The list of chronic conditions CMS is currently using to define which enrollees may receive SSBCI is the same list of conditions CMS uses to determine if an enrollee is eligible to enroll in a chronic care special needs plan. Starting in 2021, however, CMS is proposing to allow MA plans to offer SSBCI to beneficiaries who do not have one of these conditions, provided they have a chronic condition that is life threatening or significantly limits their overall health or function. As plans consider expanding their provision of SSBCI, they will need to evaluate which populations could most benefit from services that address social needs.
Avalere analyzed CMS’s Q2 2020 Plan Benefit Package files and the February 2020 Public Use enrollment file. The assessment of SSBCI reflects all MA plans with enrollment of at least 11, regardless of a plan type, in all 50 states and the territories.
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