Medicare Advantage plans this year were slow to take advantage of new flexibility to offer different kinds of supplemental benefits, but some are making up for lost time.
This week, several health plans advertised benefits for seniors that go well beyond the traditional gym membership or prescription eyeglasses. In 2020, some Advantage plans will be paying for seniors' rides to the grocery store or church, a new air conditioner or and even in-home pest control. Others are reducing co-payments for medications to treat chronic conditions, such as diabetes.
Health plans are offering the extra perks in response to new flexibility from the federal government to provide benefits that help with the social and environmental factors affecting patients' health and that are better tailored to seniors with certain chronic illnesses. Insurers expect the benefits to lure new members to their plans in an already fast-growing and lucrative Advantage market.
Cigna Corp. is piloting benefits that address its members' social needs on a market-to-market basis in several states next year to learn what works best at reducing emergency department visits and healthcare spending. Those benefits that prove successful may be rolled out elsewhere in the future, said Brian Evanko, president of the insurer's government business.
"We believe it's really important to where we can try to influence those upstream social determinants of health before it becomes a downstream acute health situation. So our orientation in this space has been to test and learn, and when something works, expand and support it in other markets," Evanko said.
The insurer will offer some Texas Medicare members with chronic obstructive pulmonary disease an allowance to buy an air conditioner. In some Colorado plans, it will introduce an allowance for acupuncture. Fall prevention programs, adult day care, broad telehealth services and expanded transportation benefits to help patients get to the grocery store or places of worship will be offered in other states. Benefits were chosen based on where Cigna saw a need.
Cigna hopes the investment in new benefits, plus a big expansion into new geographies and the introduction of PPO plans, will help it reach its goal of growing Medicare Advantage membership by 10% to 15% each year, Evanko said.
Anthem's Medicare Advantage plans in several states will offer a choice of new benefit options, including sessions with a dietitian or up to 64 healthy food deliveries per year. Other choices include quarterly pest control, health and fitness devices, an allowance to help care for a service dog, and access to acupuncture or massages.
Martin Esquivel, Anthem's vice president of product design, said the company chose which nonmedical supplemental benefits to offer and where based on what made sense financially and how much room there was in the rebate to offer those services. The plan wanted to keep benefits consistent across markets.
"It was very much a learning experience for us," Esquivel said. "We needed to understand what beneficiaries would want, what that utilization would look like, and our ability to maintain it."
UPMC Health Plan's Medicare Advantage plan, meanwhile, is offering most of its diabetic members health coaching and reduced copayments for any diabetes medication on the formulary. Patients can buy brand name diabetes drugs for a $10 copayment. UPMC has about 40,000 members with diabetes.
"We're making drugs that are critical to a disease more affordable for our members. If we remove costs as a barrier, will that lead to improved adherence? We think so," said Chronis Manolis, UPMC Health Plan's chief pharmacy officer.
Michael Bagel, the Alliance of Community Health Plan's director of public policy, which represents not-for-profit, regional health plans, said many of its members next year will offer home-delivered meals to patients after they are discharged from the hospital or transportation to and from medical appointments.
Advantage plans are also beefing up the old supplemental benefit standbys like hearing, dental, vision and prescription drug benefits in 2020, Bagel said. Insurers are taking their time to figure out what their Medicare members want and educating them on how to take advantage of it.
"It's great to offer a supplemental benefit, but it doesn't matter if the beneficiary doesn't know what it is or how to use it," he said.
The CMS in 2019 started introducing some flexibility into what types of supplemental benefits Medicare Advantage plans could offer and gave plans even more leeway to get creative in 2020. Next year plans can provide benefits unrelated to health that could reasonably improve or maintain a person's health. The can also tailor benefits for patients with chronic illnesses or reduce their cost-sharing.
Health plans don't get extra funding from the federal government to pay for supplemental benefits. Instead, they pay for them with the rebate dollars they receive from bidding below the Medicare benchmark.
Insurers were slow to offer new supplemental benefits in 2019 because they didn't have enough time to design new benefits before contract bids were due. An Urban Institute analysis also found that some Advantage plans were wary of investing in benefits that would apply only to a small number of patients. Others lacked the money to invest.
Some plans in 2019 tested the waters with new benefits in select areas, but few expanded them across all of their plans, said Gretchen Jacobsen, an associate director at the Kaiser Family Foundation.
They may have been unsure of which nonhealth-related benefits would lower healthcare spending or worried that certain benefits would attract sicker, more expensive patients from other Medicare Advantage plans or the traditional Medicare program, Jacobsen explained. For the same reasons, she said it's possible that many health plans will continue taking a cautious approach in 2020.
But, Jeff Fox, president of consultancy Gorman Health Group, which works with Medicare Advantage plans, said he expects to see a lot more action from insurers to offer benefits addressing the social determinants of health and those targeted at specific diseases like diabetes. Insurers that are good at risk adjustment should not have to worry about attracting sicker members, he said.
Fox said he expects the additional benefits to drive higher enrollment in 2020—the annual enrollment period begins Oct. 15 and ends Dec. 7—but warned that marketing creative new benefits to patients would be easier than making them work.
"But health plans have had a year to figure it out, so I think we're going to see a bigger impact in 2020," he said.