Presentation is loading. Please wait.

Presentation is loading. Please wait.

Medicare Advantage: Supplemental Benefits & Payment Reform

Published byGerardo Cosimo Corsini Modified over 5 years ago

Similar presentations

Presentation on theme: "Medicare Advantage: Supplemental Benefits & Payment Reform"— Presentation transcript:

1 Medicare Advantage: Supplemental Benefits & Payment Reform
Mike Hoak, Director of Public Policy November 9, 2018

2 Overview of Common Medicare Advantage Supplemental Benefits
Hearing Aids Dental Premium Buy-Down & Cost Sharing/OOP Max Reductions Vision

3 Changes to MA Supplemental Benefits in 2019
The Centers for Medicare and Medicaid Services (CMS) issued regulations in April 2018 providing plans with greater flexibility to offer more tailored and more diverse supplemental benefits beginning in 2019. Targeted Cost Sharing Reductions Tailored Benefits Wider Range of Potential Benefit Offerings Plans can provide reduced cost sharing for certain services for beneficiaries with targeted conditions. For example, plans could reduce the cost sharing amount for diabetes members visiting their endocrinologist. Plans can elect to offer certain benefits solely for members with certain targeted conditions. For example, plans could cover more frequent foot exams as a tailored benefit for diabetes members. Plans can elect to cover a wider range of supplemental benefits for members with targeted conditions, including adult day care services, home-based palliative care, in-home support services, and non-Medicare covered safety devices.

4 “ 2019 Will Be a Learning Year Plans Had Little Time to Prepare
A supplemental benefit is not primarily health related under the previous or new definition if it is an item or service that is solely or primarily used for cosmetic, comfort, general use, or social determinant purposes The new regulations and sub-regulatory guidance were issued only weeks before final MA bids were due to CMS. Social Determinants of Health Were Excluded Plans were prohibited from using supplemental benefits to address social determinants of health, such as food insecurity. CMS, April 27, 2018 HPMS Memo Plans Will Have Even More Options in 2020 Congress passed legislation in 2018 providing plans with even more supplemental benefit flexibility beginning in CY 2020.

5 Changes Coming for 2020 Balanced Budget Act of 2018
Much Wider Range of Supplemental Benefits – Supplemental benefits are no longer required to be “primarily health related,” opening the door for benefits that address social determinants of health. Benefits May Be Tailored to the Needs of Each Specific Member – Plans will have the flexibility to offer different supplemental benefits based on the individual needs of each member. Expanded Telehealth Coverage in MA Basic Benefit – Plans will be allowed to waive geographic and originating site restrictions that apply in traditional Medicare, opening the door to a wider array of telehealth offerings. Balanced Budget Act of 2018

6 Value-Based Payment Reform

7

8

9 Humana Value-Based Care Report
52,000 1,000+ 1.9M Individual Humana MA members … … affiliated with 52,000 primary care physicians… …in more than 1,000 value-based agreements across 43 states *2017 Humana Value-Based Care Report available at

10 Integrated, Value-Based Care Results in Improved Quality and Lower Costs

11 Questions?

Download ppt "Medicare Advantage: Supplemental Benefits & Payment Reform"

Similar presentations

Optima Medicare (PPO) Plans CY 2010. Medicare Medicare is a Federal health insurance program for those age 65 or older or individuals at any age who have.

Optima Medicare (PPO) Plans CY Medicare Medicare is a Federal health insurance program for those age 65 or older or individuals at any age who have.
Health Insurance Options and Benefits.

Health Insurance Options and Benefits.
Center on Budget and Policy Priorities cbpp.org Medicaid To Expand or Not to Expand ACA Implementation in Indiana: Challenges, Strategies and Solutions.

Center on Budget and Policy Priorities cbpp.org Medicaid To Expand or Not to Expand ACA Implementation in Indiana: Challenges, Strategies and Solutions.
Introduction to Medicaid Roger Auerbach Rutgers Center for State Health Policy Regional Housing Conference September 10, 2003.

Introduction to Medicaid Roger Auerbach Rutgers Center for State Health Policy Regional Housing Conference September 10, 2003.
Medicare Supplement vs Medicare Advantage For authorized agent use only. Not for public use.

Medicare Supplement vs Medicare Advantage For authorized agent use only. Not for public use.
The Affordable Care Act and the Kentucky Health Benefit Exchange.

The Affordable Care Act and the Kentucky Health Benefit Exchange.
Essential Standard 4.00 Understand financial, credit, and insurance law Health Insurance 4.02 C BB30 Business Law 4.02Summer 2013.

Essential Standard 4.00 Understand financial, credit, and insurance law Health Insurance 4.02 C BB30 Business Law 4.02Summer 2013.
Medicare Part D Overview of Options, Creditable Coverage, Required Notices, COB and Health Care Reform.

Medicare Part D Overview of Options, Creditable Coverage, Required Notices, COB and Health Care Reform.
Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible.

Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible.
Virginia’s Blueprint for the Integration of Acute and Long-Term Care Services The Second National Medicaid Congress Cindi B. Jones, Chief Deputy Director.

Virginia’s Blueprint for the Integration of Acute and Long-Term Care Services The Second National Medicaid Congress Cindi B. Jones, Chief Deputy Director.
There’s So Much More to Medicare, Let’s Talk Humana Medicare Advantage Health and Prescription Drug Plans M0006_GH210S6RR KC0906.

There’s So Much More to Medicare, Let’s Talk Humana Medicare Advantage Health and Prescription Drug Plans M0006_GH210S6RR KC0906.
“Securing Health Rights for Those in Need” Strengthening the Medical Home through Utilization of EPSDT Manjusha P. Kulkarni Staff Attorney Child Health.

“Securing Health Rights for Those in Need” Strengthening the Medical Home through Utilization of EPSDT Manjusha P. Kulkarni Staff Attorney Child Health.
Issues and Challenges Facing Medicare Mark L. Hayes.

Issues and Challenges Facing Medicare Mark L. Hayes.
© 2010 Principles of Healthcare Reimbursement Third Edition Chapter 4 Government-Sponsored Healthcare Programs.

© 2010 Principles of Healthcare Reimbursement Third Edition Chapter 4 Government-Sponsored Healthcare Programs.
Return to Tutorials Tricia Neuman, Sc.D. Director, Medicare Policy Project Vice President, Kaiser Family Foundation For KaiserEDU June 2009 Medicare 101:

Return to Tutorials Tricia Neuman, Sc.D. Director, Medicare Policy Project Vice President, Kaiser Family Foundation For KaiserEDU June 2009 Medicare 101:
Vince Kelly Medicare Insurance Specialist Phone number 310-625-1837 Important Phone Numbers.

Vince Kelly Medicare Insurance Specialist Phone number Important Phone Numbers.
COBRA EXPANSION How It Impacts You. What Is COBRA? The opportunity to continue group health coverage when there is a “qualifying event” that would result.

COBRA EXPANSION How It Impacts You. What Is COBRA? The opportunity to continue group health coverage when there is a “qualifying event” that would result.
Medicaid In The Schools (MITS) National Picture of School-Based Medicaid Programs January 2008.

Medicaid In The Schools (MITS) National Picture of School-Based Medicaid Programs January 2008.
1 Legislative Update. 2 National Health Reform Update Senate HELP Bill –Detail missing Senate Finance –Three options papers set the stage –OMB scores.

1 Legislative Update. 2 National Health Reform Update Senate HELP Bill –Detail missing Senate Finance –Three options papers set the stage –OMB scores.
Medical Coding & Insurance Unit 8 Seminar. CMS Centers for Medicare and Medicaid Services (CMS) Centers for Medicare and Medicaid Services (CMS) Purpose:

Medical Coding & Insurance Unit 8 Seminar. CMS Centers for Medicare and Medicaid Services (CMS) Centers for Medicare and Medicaid Services (CMS) Purpose:

Similar presentations

Ads by Google