Few 2019 MA Plans Test New HCBS Supplemental Benefits

Regulation | October 01, 2018 | by Nicole Fallon

CMS unveiled the 3700 Medicare Advantage (MA) and Part D Prescription Drug plans that will be available to Medicare beneficiaries beginning in 2019. CMS reports about 270 of these plans (roughly 7%) are offering some of the new supplemental benefit options, including adult day services and in-home and caregiver support services; and reduced cost sharing for targeted enrollees (e.g., diabetics, congestive heart failure) taking advantage of the new flexibility CMS provided related to uniform benefits requirements.

These new supplemental benefit options were added in April 2018 when CMS announced in its Call Letter that it had re-interpreted the definition of “primarily health-related” opening the door to some limited home and community-based services being covered by MA plans who previously could only cover Medicare services. CMS applies some limits to the scope of these new benefits including they must be medically appropriate, and ordered or directly provided by a licensed provider as part of a care plan.  CMS also noted in its Call Letter that these benefits may be targeted or time limited. 

CMS also noted that it projects MA plan enrollment to grow by an additional 2.4 million Medicare beneficiaries in the 2019 bringing total enrollment to 22.6 million or nearly 37%. Of those enrollees who are continuing their MA plan coverage in 2019, 83% will have the same or a lower premium than in 2018. MA plan premiums on average nationally will decline 6%. Access to MA plans continues to improve with 91% of beneficiaries having a choice of 10 or more plans and 99% having access to at least one MA health plan, while all Medicare beneficiaries will have at least one Part D plan offered in their county.

Medicare beneficiaries’ open enrollment begins October 15 and continues through December 7, 2018.