CMS Announces innovative changes to Medicare Part D and Medicare Advantage plans.

“The American healthcare system is very different today than it was thirteen years ago when the Medicare Advantage and Part D programs were launched in their current forms, but due to the slow pace of change in government, these programs have not been fully updated to reflect today’s realities,” said CMS Administrator Seema Verma.

CMS’s Center for Medicare and Medicaid Innovation (“Innovation Center”), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model and transformative updates to an existing model.  The models are designed to enable Medicare Advantage and Part D plans, which are private plans that provide Medicare beneficiaries with medical and prescription drug coverage, to better serve patients and help them achieve good health.

The wide-ranging enhancements to the Value-Based Insurance Design (VBID) model announced today will test a new series of service delivery approaches for Medicare Advantage plan beneficiaries for the 2020 plan year, including:

  • Allowing plans to provide reduced cost sharing and additional benefits to enrollees in a more targeted fashion than has previously been allowed, including customization based on chronic condition, socioeconomic status, or both, and even for benefits not primarily related to health care, such as transportation;
  • Bolstering the rewards and incentives programs that plans can offer beneficiaries to take steps to improve their health, permitting plans to offer higher value individual rewards than were previously allowed; and
  • Increasing access to telehealth services by allowing plans to use access to telehealth services instead of in-person visits, as long as an in-person option remains, to meet a range of network requirements, including certain requirements that could not previously be fulfilled through telehealth.

Beginning in the 2021 plan year, the VBID model will also test allowing Medicare Advantage plans to offer Medicare’s hospice benefit.  This change is designed to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians.

Plans participating in the VBID program will be offered along with traditional Medicare Advantage plans.  CMS will monitor whether plans that take up these more tailored coverage options are able to reduce costs and increase quality.

“This is all great news for agents and their Medicare clients as health plans will be able to deliver products designed to lower costs and improve the quality of care for beneficiaries by providing services and benefits tailored to their needs,” said UIG Vice President, Brokerage Graham Smith.

Full CMS Press Release