Among Medicare Advantage plans, 53 will be covering hospice and palliative care in 2021 through the value-based insurance design (VBID) model, according to the U.S. Centers for Medicare & Medicaid Services (CMS). Medicare Advantage is seeing record-high levels of participation for 2021 among beneficiaries, reaching about 42% for 2021, CMS reported.
Starting in 2021, payers and hospice providers will have the option to participate in a demonstration project testing the inclusion of hospice in VBID. The demonstration is often referred to as the Medicare Advantage hospice carve-in.
The carve-in will begin at a time when Medicare Advantage premiums have dropped precipitously despite expanding benefits, even as the number of beneficiaries who opt into those plans swells nationwide. Premiums are down more than 30% for 2021.
“The offerings this year are really going to be very robust. It’s an increasingly robust and competitive marketplace with low beneficiary premiums on the one hand, and also an exciting increase in the number of plans that are offering the additional types of supplemental benefits,” said Anne Tumilson, CEO of ATI Advisory. “It’s a really good marketplace for beneficiaries, when not only are their prices for enrolling are lower than they have been in the past, but the number of new and innovative types of benefits that the plans are offering is higher.”
Among those benefits is increased access to palliative care services, as well as telehealth. Law requires Medicare Advantage plans to cover all of the services offered by traditional Medicare but also allows for certain supplemental benefits, including palliative care.
Historically these benefits were very limited, but the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act (CHRONIC), passed by Congress in 2018, expanded the range of those benefits to include programs to address some social determinants of health as well as home-based palliative care.
Close to 730 plans will offer supplemental benefits to approximately 3 million Medicare Advantage beneficiaries in 2021, some of which are considered in-home support. In addition to palliative care, the in-home support benefits include adult day health services, caregiver support services, in-home support services, and therapeutic massage.
Hospices provide about 50% of home-based palliative care in the United States according to the Center to Advance Palliative Care, and the number of providers that are diversifying their services lines to include palliative care continues to increase.
On the telehealth front, which has become an imperative during the COVID-19 pandemic, more than 94% of plans will cover those services next year, up from 58% during 2020.
“When you think about what’s going to be appealing to plans and to members in 2021 in the environment that we’re living in these days, I do think we’re likely to see some really significant growth in-home support services,” Tyler Cromer, principal at ATI Advisory, said. “I don’t expect a ton of growth in adult day or health services right now. CMS will release the detailed data about those benefits in October, but I think we can expect some fairly significant growth in that in-home support services category.”