New Opportunities for Medicare Advantage Plans to Differentiate

Mark Seghers

Medicare Advantage (MA) Plans currently account for 35% of the Medicare marketplace – and this is growing steadily every year, from 6.8 Million in 2006 to 22 Million in 2019. MA plans by law must offer at least the same level of coverage as Original Medicare (A and B) – and they may reduce a beneficiary’s total out-of-pocket costs.

Further, many MA plans offer added benefits, which may include coverage for routine vision care, hearing aids, routine dental care, prescription drug coverage, and fitness center membership. These supplemental benefits provide additional, and sometimes dramatic value, and can help an MA plan differentiate itself from other plans in their market.

Historically, supplemental benefits were required to be health-related but in 2019 CMS changed the rules governing supplemental benefits to:

  • Allow more benefits to qualify as “primarily health-related”

  • Allow special benefits for people with chronic diseases; and

  • Allow insurers to tailor supplemental benefits to enrollees.

In other words, the benefit must “diagnose, prevent, or treat an illness or injury; compensate for physical impairments; act to ameliorate the functional/ psychological impact of injuries or health conditions; or reduce avoidable emergency and healthcare utilization.” CMS has offered only this broad guidance and it will be up to the MA Plans to submit benefits for CMS’ approval.

These changes are expected to significantly expand the number of MA plans which offer supplemental benefits, and, possibly, broaden the types of benefits available to consumers. Further, this expansion may give smaller MA plans a chance to differentiate themselves in a heavily competitive – and big-company-dominated – MA market.

This broadening of the definition of health coverage allows many benefits with reasonable health ties to be offered, including things like meal delivery, transportation for medical appointments as well as non-medical needs like grocery shopping, etc.

Products like HealthIO - which give the member the ability to self-monitor their own vitals and share with loved ones and care givers - can provide benefits, may be more valuable than meal delivery and transportation:

  • HealthIO can help physicians and caregivers diagnose, prevent or treat an illness – especially when targeting those with chronic conditions as is now allowed by CMS.

  • HealthIO can help a patient stay compliant to prescribed medication regimens.

  • HealthIO enables regular monitoring of vitals at home which increases the chances of health issues being caught early. This has the potential to reduce in-person visits by nurses and/or trips to emergency rooms, resulting in lower health care costs for individuals, employers and plans.

All in all, a remote monitoring benefit – either preventive or along with management of an existing condition - could turn out to be one of the most valuable supplemental benefits an MA Plan could offer.

In 2020, over 500 plans are expected to offer supplemental benefits to over 2.6M Beneficiaries. By offering the right health-related benefits – which can truly help their members be healthier - MA plans can do a lot more than just compete – they can lower Medical Loss Ratio and improve members’ perception of quality and value.

When people manage their own health – everybody wins.