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CMS expands Medicare Advantage value-based insurance design model

In 25 states starting in 2019, plans will be able to provide Medicare beneficiaries with more choices and lower cost, CMS says.

Susan Morse, Managing Editor

Image via <a href="">Matthew Bisanz</a>.Image via Matthew Bisanz.

The Centers for Medicare and Medicaid Services is expanding the Medicare Advantage value-based insurance design model to an additional 15 new states and will allow insurers greater flexibility in enrolling beneficiaries with chronic conditions.

Starting in 2019, insurers in the selected VBID model states can expand the model to include more Medicare beneficiaries with  chronic conditions than previously identified by CMS. This includes beneficiaries with lower back pain, chronic kidney disease, obesity/pre-diabetes, asthma, and tobacco use.

[Also: AHIP thanks CMS for adding flexibility in 2019 Medicare Advantage and Part D rule]

It will also allow insurers to propose their own systems or methods for identifying eligible enrollees.

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The reduced cost sharing for customized benefits for beneficiaries that meet specific medical criteria is intended to lower the cost of coverage, CMS said.

[Also: CMS lightens the reporting load for Medicare Advantage, Part D, changes how star ratings are calculated]

The VBID model will be available in 25 states in 2019.

This includes ten Medicare Advantage plans from 2018 and another 15 in 2019.

Current states in the model are: Alabama, Arizona, Indiana, Iowa, Massachusetts, Michigan, Oregon, Pennsylvania, Tennessee, and Texas.

For 2019, this will be expanded to include: California, Colorado, Florida, Georgia, Hawaii, Maine, Minnesota, Montana, New Jersey, New Mexico, North Carolina, North Dakota, South Dakota, Virginia, and West Virginia.

Medicare Advantage organizations, even those currently in the model, must submit an application by January 26, 2018 to be eligible in 2019.

The Medicare Advantage value-based insurance design model  encourages customized benefit designs and flexibility.

CMS also recently announced new flexibilities in a Medicare Advantage and Part D proposed rule.
"This Administration is committed to making sure that our seniors have more choices and lower premiums in their Medicare Advantage plans," said CMS Administrator Seema Verma. "CMS expects that this demonstration will provide insights into future innovations for the Medicare Advantage program."

Enrollment in Medicare Advantage is at an all-time high, with about a third of Medicare beneficiaries enrolled, according to CMS.

The number of Medicare Advantage plans has increased from about 2,700 in 2017 to more than 3,100 in 2018. Eighty-five percent of Medicare beneficiaries will have access to 10 or more Medicare Advantage plan choices in 2018, CMS said.

Twitter: @SusanJMorse
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