MA palliative care benefits see little growth in 2023, but interest from payers remains high


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

Among Medicare Advantage supplemental benefits, home support services and caregiver support saw the strongest year-over-year growth for 2023. The number of plans offering palliative care at home will increase to 157 l next year compared to 147 in 2022, according to an analysis by ATI Advisory. This does not include the Special Supplementary Benefits for the Chronically Ill (SSBCI).

These benefits are voluntary components of the Medicare Advantage program and are among the few reimbursement options for hospice providers.

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

“I wouldn’t read into it too much. I think Medicare Advantage plans are very interested in palliative care, and I think there are other vehicles out there,” Cromer told Hospice News. “So I’d like to keep a close eye on what’s happening in the Value Based Insurance Design Demonstration (VBID), particularly with respect to the hospice component, because we don’t have that data. But my feeling is that we will see some innovation in this space in VBID.

Through Medicare Advantage, the US Centers for Medicare & Medicaid Services (CMS) contracts with private insurance companies to provide coverage for Medicare beneficiaries. The law requires Medicare Advantage plans to cover all services offered by traditional Medicare, excluding palliative care, and also allows for certain additional benefits.

CMS is currently testing palliative care coverage through Medicare Advantage through a component of the four-year VBID demonstration – often referred to as the Medicare Advantage carve-in. The carve-in launched on January 1, 2021, with 53 participating health plans. That number grew to 115 in 2022. Next year, 119 plans will participate, according to the US Department of Health and Human Services (HHS).

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

Home support services saw the strongest growth in plan membership for 2023, rising to 1,091 from 729 the previous year. These services include non-medical home care and other forms of assistance with daily activities.

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

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

This chart from ATI Advisory shows plan membership growth in 2023 for a range of additional Medicare Advantage benefits.

CMS allows Medicare Advantage plans to target specific populations among their enrollees to receive additional benefits — such as those with critical illness or high healthcare utilization — rather than offering the same benefits to everyone. the registered ones.

Historically, these benefits were very limited, but Congress in 2018 expanded the range of these benefits to include programs to address certain social determinants of health as well as palliative home care.

Hospices provide approximately 50% of home palliative care in the United States according to the Center to Advance Palliative Care, and the number of providers diversifying their service lines to include palliative care continues to grow.

Palliative home care could reduce health care costs for society by $103 billion over the next 20 years, the nonprofit economics research group Florida TaxWatch said in a 2019 report.

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

“The plans work with providers to design benefits that can be provided to support their members,” Cromer said. “We’re going to continue to see growth in the market and growth in understanding what it means to really be able to design and deliver those benefits in a meaningful way.”

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

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