This past April, the Centers for Medicare and Medicaid Services (CMS) released updates to the Medicare Advantage (MA) and Medicare Prescription Drug Plans (Part D) programs for the upcoming 2020 year. Focused on improving quality and choice for patients, many of these modifications come as a result of the Bipartisan Budget Act of 2018, which includes changes to Medicare programs. CMS is adding flexibility to MA plans that will not only provide patients with more MA options and new benefits, but also take a significant step toward offering higher quality care at lower costs.
MA plan premiums are not announced until later this fall, but it should be expected that plans will take advantage of these new rules to offer expanded benefits to beneficiaries. CMS is already improving its plan-finder tool to help patients see which MA plans are offering these new services.
Understanding what is changing for the 2020 plan year is important for pharmacists as patients will look to compare and switch Medicare plans during Open Enrollment this fall. To help, here’s a breakdown of some of the major benefits plans may offer or continue to offer next year:
Expanding Telehealth Services
The telehealth market is experiencing considerable growth, with a recent study projecting the global market will hit $130.5 billion by 2025. So it comes as no surprise that the Bipartisan Budget Act made provisions to include additional telehealth benefits in MA plans starting next year. By expanding telehealth coverage, beneficiaries will be able to receive healthcare services from the convenience of their homes as opposed to traveling to healthcare facilities.
That said, telehealth benefits are not new to MA plans. Previously, MA plans could offer additional telehealth services as a supplemental benefit paid through rebates or premiums. With the new changes, however, these services will be considered a basic government-funded benefit outside of what Original Medicare offers. MA patients, who have always had more telehealth benefits than Original Medicare patients, will likely see their network of providers expand, regardless of whether they are in urban or rural areas.
Improved Benefits for Chronic Illnesses
The provisions of the Bipartisan Budget Act also spell good news for MA patients with chronic illnesses such as diabetes and heart disease. Thanks to the updates, these patients will have access to a wider range of supplemental benefits that may not be health related but “have a reasonable expectation of improving or maintaining the health or overall function” of enrollees, according to CMS. These can include meal delivery services, transportation for non-medical needs, or home environment services that improve a patient’s health. For instance, someone with asthma will be able to cover home air cleaners that help lower their risk of asthma attacks and being sent to the hospital. MA plans can also vary supplemental benefits by tailoring them to a patient’s specific needs and medical conditions.
The CMS’ expansion of transportation benefits extends beyond only patients with chronic illnesses. Under these changes, plans can begin offering transportation benefits for more than just critical care services. Transportation to preventative services, such as wellness visits or massage therapy, can now be covered.
This expansion is particularly interesting as ride-sharing companies like Uber continue to increase healthcare footprint by partnering with Medicare, Medicaid, and Medicare Advantage plans. Currently, MA plans cover Uber Eats, but Uber Health is looking to expand its meal delivery program to include deliveries of pharmaceuticals and durable medical equipment. According to Uber, its main priority in partnering with plans is helping beneficiaries in low-income at-risk populations have better access to healthcare.
Targeting Opioid Use
As part of its efforts to fight against the opioid epidemic, CMS is implementing additional policies for 2020. The agency is pushing for plans to use their new flexibility to help reduce cost-sharing for patients suffering from chronic pain or undergoing addiction treatment. In particular, plans are encouraged to lower cost-sharing for opioid overdose-reversal agents like naloxone.
The updated guidelines for the use of opioids will be added as display measures, which may be officially incorporated into the Star Rating System. These display measures will be used to evaluate Medicare plans in 2020, and while they don’t impact a plan’s ratings immediately, they will likely be considered for inclusion in the 2023 Star Ratings based on 2021 data.
CMS is also pushing for plans to incorporate “complementary and integrative treatments” for pain management in plan designs. Some of these benefits include peer support services, non-Medicare covered chiropractic services, acupuncture, and therapeutic massages by licensed massage therapists.
Nicotine Replacement Therapy
Increasingly, states are authorizing pharmacists to prescribe medications to help people quit smoking, giving them an even bigger role in influencing tobacco use. In fact, a 2014 study found that tobacco cessation programs provided by pharmacists were just as successful as those provided by other healthcare practitioners. There’s also the added benefit of being more accessible to patients across the board.
This role augments the benefits for nicotine replacement therapies offered by MA plans, which give patients more access to services that help them stop smoking. This benefit was particularly popular in 2019 as it was the most commonly offered new benefit in a list that also included OTC supplements, caregiver support, in-home support services, and adult day care services. It is expected that this benefit will carry over into the next plan year.
In addition to the benefits listed above, CMS is implementing a policy that keeps cut points from increasing or decreasing more than a 5% cap each year. This will reduce the impact of outliers in a plan and create more stability in the Star Rating System. In 2019, 50% of MA plans offered these OTC supplemental benefits, according to a Healthscape analysis of CMS data, leading to significant growth in MA plan enrollment. When MA plan specifics are announced later this year, it will be interesting to see which benefits are offered and whether or not premiums will rise as a result of these extra benefits.