Medicare Advantage Advanced Notice for 2020: Key insights

Feb. 13, 2019 / By Gretchen Mills

CMS has released the Advance Notice Parts I and II per the annual cycle of Medicare Advantage (MA) regulatory guidelines for the coming year. The Advance Notices provide the parameters for the MA plan benefit designs and an overall estimate of the plan payment rate increase. The plans have a comment period in which to respond. Typically, CMS makes very few changes from the Advance Notice draft regulations.

This year, I think MA plans will be happy with the flexibility that CMS is providing. One of the foundational building blocks for MA benefit plans is the concept of “uniformity,” meaning that all enrolled Medicare beneficiaries are entitled to the same set of benefits, regardless of age, sex or medical condition. For 2020, CMS is encouraging MA plans to offer unique benefits specifically for individuals with specific chronic diseases. Thus, plans will be allowed to offer disease specific benefits and services for certain chronic conditions. CMS is essentially making the Value-based Insurance Design Pilot (VBID), national in 2020 with this benefit flexibility. CMS piloted the VBID in 2017 in 7 states and expanded it to 10 states in 2018.

This flexibility will allow plans to design disease management and targeted case management with specific benefits for specific diseases. At the same time, CMS is giving more flexibility to plans to offer supplemental benefits that go beyond the perennial fitness club and eyeglass benefits. As the impact of social determinants of health on both quality of life and total healthcare costs has become widely understood and accepted, we can expect to see more MA plans offering targeted services for food insecurity, access to care and even loneliness in 2020.

All this is very good news for beneficiaries and could drive even higher enrollment in this rapidly growing program.

Gretchen Mills is manager of market strategy for populations and payment solutions at 3M Health Information Systems.