MA Palliative Care Benefits See Little 2023 Growth, But Payer Interest Remains High

Only 10 new Medicare Advantage (MA) plans will offer home-based palliative care as a primarily health-related benefit for 2023, but payers may be offering those services through other programs.

Among Medicare Advantage supplemental benefits, in-home support services and caregiver support saw the most year-over-year growth for 2023. The number of plans offering home-based palliative care will rise to 157 next year from 147 in 2022, according to an analysis by ATI Advisory. This does not include special supplemental benefits for the chronically ill (SSBCI).

These benefits are voluntary components of the Medicare Advantage program and are among the few avenues for reimbursement for palliative care providers.


But the relatively small increase in plans doesn’t necessarily signal a lack of interest, according to Tyler Overstreet Cromer, principal of ATI Advisory’s Medicare Innovation Team.

“I wouldn’t read too much into it. I think Medicare Advantage plans are very interested in palliative care, and I think there are other vehicles,” Cromer told Hospice News. “So I would want to keep a close eye on what’s happening in the value-based insurance design demonstration (VBID), particularly as it relates to the hospice component, because we don’t have that data. But my sense is that we will see some innovation in that space in VBID.”

Through Medicare Advantage, the U.S. Centers for Medicare & Medicaid Services (CMS) contracts with private insurance companies to provide coverage for Medicare beneficiaries. Law requires Medicare Advantage plans to cover all of the services offered by traditional Medicare, excluding hospice, and also allows for certain supplemental benefits.


CMS is currently testing hospice coverage through Medicare Advantage through a component of the four-year VBID demonstration — often called the Medicare Advantage carve-in. The carve-in launched Jan. 1, 2021, with 53 participating health plans. This number grew to 115 in 2022. Next year, 119 plans will participate, according to the U.S. Department of Health & Human Services (HHS).

Geographically, the program will be available in 806 counties in 24 states, up from 461 in 2022.

In-home support services saw the most growth in plan participation for 2023, rising to 1,091 from 729 the prior year. These services include non-medical home care and other assistance with daily activities.

Caregiver support showed the second-highest growth. Next year, 293 plans will offer the benefit compared to 160 in 2022.

“There is a growing awareness that caregivers — these are family caregivers typically — are an important part of the care for so many Medicare beneficiaries,” Cromer said. “I think this signals growing awareness on the part of plans that you can support your members by supporting the people who care for them.”

This chart by ATI Advisory shows 2023 plan-participation growth for a range of Medicare Advantage supplemental benefits.

CMS permits Medicare Advantage plans to target specific populations among their enrollees to receive supplemental benefits — such as those with serious illness or high-health care utilization — rather than offering the same benefits to all enrollees.

Historically these benefits were very limited, but 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.

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 service lines to include palliative care continues to increase.

Home-based palliative care could reduce societal health care costs by $103 billion within the next 20 years, the nonprofit economic research group Florida TaxWatch said in a 2019 report.

The details on these benefits can vary among different health plans in terms of the specific services provided and the amount of those services that will be covered, among other factors.

“Plans are working with providers to design benefits that can be delivered to support their members,” Cromer said. “We’re going to continue to see growth in the marketplace and growth in the understanding of what it means to really be able to design and deliver these benefits in a meaningful way.”

Home Health Care News Editor Andrew Donlan contributed to this report.

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