Study Shows Medicare Advantage Plans Are Growing Enrollment and Offering More Non-Medical Supports and Expanded Health-Related Benefits

Members should take note of a recently released report from ATI Advisory, “Growth in New, Non-Medical Benefits Since Implementation of the Creating High Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act,” which highlights the increased provision of Special Supplemental Benefits for the Chronically Ill (SSBCI) by Medicare Advantage through the CHRONIC Care Act. The report also shows increased access to Expanded Primarily Health-Related Benefits (EPHRB), which first became available in 2019 after the Centers for Medicare and Medicaid Services (CMS) expanded the definition of what could be considered “primarily health-related” under Medicare Advantage.

Non-medical supplemental benefits include the following: food and produce, meals, pest control, transportation for non-medical needs, indoor air quality equipment and services, social needs benefit, complementary therapies, services supporting self-direction, structural home modifications, and general supports for living.

EPHRB measured in the study include therapeutic massage, adult day health care (ADHC), home-based palliative care, in-home support services, and support for caregivers of enrollees.

The study finds that “[s]ince 2020, there has been a dramatic increase in the number of plans offering these benefits, the number of beneficiaries enrolled in plans offering these benefits, and the availability of these benefits geographically. For Plan Year (PY) 2022, one in every four MA plans offers SSBCI, while one in every three plans offers SSBCI and/or EPHRB. Presently, 98 percent of MA beneficiaries reside in a county with at least one plan offering these new benefits, through any authority. Most commonly, we find that benefits designed to meet beneficiaries’ nutritional needs and needs in the home, including help with activities like cleaning, meal preparation, and ambulating, are the most popular of the newer supplemental benefits. While these benefits are available more broadly in PY 2022, they are, by no means, ubiquitous. Continued study and evaluation of the availability and, most critically, utilization of these benefits is necessary in the future.”

Some of the study’s findings indicate increases due to pandemic-related experiences of beneficiaries. Some decreases in offerings relate to some health care provider challenges during and after the pandemic to deliver care due to closures or staffing shortages.

Contact: Meg Everett, meverett@leadingageny.org, 518-929-9342