Reimbursement

More Flexibility for Medicare Advantage

February 8, 2019

 

More Flexibility for Medicare Advantage

 

The Centers for Medicare & Medicaid Services (CMS) continues to give Medicare Advantage health plans more freedom to expand health benefits, especially related to chronic conditions and telehealth. The goal is to encourage greater use of preventive care and other tools to manage complex health conditions.

 

Medicare Advantage (MA) is the portion of Medicare that allows beneficiaries to receive their benefits through health plans offered by private insurance companies. Roughly 19 million Medicare beneficiaries—about one third—are enrolled in MA.

 

  • Starting in 2019, Medicare Advantage plans can offer targeted benefits and services, including reductions in cost-sharing, for groups of patients based on their health status or disease. This might include, for example, more frequent foot exams for diabetes patients or reduced cost-sharing for visits to specialists. Previously, supplemental benefits had to be offered to all enrollees, not just a subset.
  • Starting in 2020, Medicare Advantage plans can offer supplemental benefits to chronically ill patients that help improve or maintain a patient’s overall health or functioning, such as home delivered meals and transportation for non-medical needs. These benefits could also be tailored to the needs of individual patients, and would not have to be offered to other enrollees.
  • Also starting in 2020, Medicare Advantage plans are permitted to offer—as part of the basic benefit package—additional telehealth benefits beyond what is currently allowed under traditional Medicare. This would allow use of telehealth in rural and urban locations, including the patient’s home. CMS also announced that, beginning in 2020, it will expand a value-based demonstration project for Medicare Advantage plans that increases access to telehealth services as a substitute for in-person visits.

 

CMS recently issued proposals to implement several of these policies.