While Medicare Advantage (MA) plans have new flexibility to target and cover supplemental benefits that address health-related social needs, few plans provided these types of benefits in 2019. Multiple factors may impede the ability of plans to comprehensively address these social needs.
MA plan representatives cited multiple factors that may limit the expansion of these supplemental benefits. First, insurers must rely on limited and varied funding from plan rebates to cover these benefits. These supplemental benefits are funded by rebates for MA plans that bid below the county-level benchmark set by the Centers for Medicare & Medicaid Services (CMS), and rebates averaged $107 per member for month across all MA plans with wide variation across states and counties.
Additionally, MA plan representatives perceived challenges in key areas, including contracting with community-based organizations, identifying benefits with a potential return on investment, and dedicating resources to new types of benefits such as housing supports. Since available benefits will vary based on county as well as by enrollee health conditions, plans anticipate challenges with enrollee communication and marketing. Plan representatives suggested opportunities to improve benefit flexibility policies, including the provision of additional funding from CMS to MA plans.
- What resources can Medicare Advantage plans use to address enrollees’ health-related social needs?
- How are Medicare Advantage plans making decisions around new flexibilities for benefits to address health-related social needs?