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New Medicare Advantage Benefits Offer Social Services to People with Chronic Illness

Medicare Advantage Benefits

Amid court battles and contentious congressional hearings on other matters, the Trump administration released guidance last week that is good news for people with chronic conditions. Starting in 2020, Medicare Advantage plans — private health plans that contract with Medicare — will be allowed, but not required, to offer chronically ill enrollees nonmedical services for social needs that affect health. This is an important step for Medicare. Many older Americans, particularly those who are very sick, will greatly benefit given their high levels of unmet social needs.

Medicare Advantage plans will be able to select which nonmedical services they offer, as long as there is a “reasonable expectation that the services will help people with chronic conditions improve or maintain their health or overall function.” Examples of these services include: home-delivered meals, transportation for nonmedical needs, pest control, indoor air quality equipment (e.g., air conditioner for someone with asthma), and minor home modifications (e.g., permanent ramps, widening of hallways or doorways to accommodate wheelchairs).

This new coverage flexibility was made possible by the CHRONIC Care Act, part of the Bipartisan Budget Act of 2018 that President Trump signed into law last year. The CHRONIC Care Act opened the door for Medicare Advantage plans to address the social determinants that impact their enrollees’ health. The law also gave health plans new flexibility to target benefits to a subset of patients who would particularly benefit from them. Prior to the legislation, Medicare Advantage plans were required to offer the same benefits to all their Medicare enrollees.

Of course, there are issues to watch. It’s uncertain whether or not health plans will decide to offer nonmedical services, which will be considered “special supplemental benefits.” Based on the feedback we’ve received from Medicare Advantage plan leaders and health providers, we know they will need practical guidance and support on how to integrate nonmedical services into their data systems, referral networks, payment structure, consumer outreach, and provider education. Decisions to offer these supplemental benefits will likely depend on whether the plans view them as prudent investments.

Health plans that choose to offer nonmedical services will need to develop metrics to monitor and track progress, as well as assess if the availability of social services results in better quality outcomes, greater patient satisfaction, and more efficient use of health care services.

Ultimately, the potential for improving care and lowering health care costs lies in determining how to provide care informed by patients’ medical and social needs. It also requires that we create appropriate incentives for insurers to cover critical nonmedical services that significantly affect patients’ health. To that end, the new federal guidance for Medicare Advantage plans holds real promise for realizing direct, tangible improvements in patients’ outcomes and on the overall costs of care.

Publication Details

Publication Date: April 8, 2019
Contact: Melinda K. Abrams, Vice President and Director, Delivery System Reform, The Commonwealth Fund
Email: mka@cmwf.org
Citation:

Melinda K. Abrams and Shawn M. Bishop, “New Medicare Advantage Benefits Offer Social Services to People with Chronic Illness,” To the Point (blog), Commonwealth Fund, Apr. 8, 2019. https://doi.org/10.26099/pm2a-gt42

Experts

Melinda K. Abrams
Vice President and Director, Delivery System Reform, The Commonwealth Fund
Shawn Bishop
Vice President, Controlling Health Care Costs and Advancing Medicare, The Commonwealth Fund