35% More MA Plans Offering Home-Based Supplemental Benefits in 2023

More Medicare Advantage plans are offering supplemental benefits in 2023, including in-home support services and home-based palliative care, according to a report commissioned by Better Medicare Alliance (BMA), prepared by consulting firm Milliman.

In 2018, CMS issued guidelines allowing Medicare Advantage plans more flexibility regarding the supplemental benefits they could offer beneficiaries. The guidance expanded benefit types to include primarily health-related supplemental benefits, such as in-home support services, caregiver support, home-based palliative care, and therapeutic massage.

Milliman analyzed CMS reports since 2019 to identify Medicare Advantage plans that offered primarily health-related supplemental benefits after the guidance was implemented.

Between 2022 and 2023, the number of Medicare Advantage plans to offer at least one of the expanded benefits increased by 35 percent, rising from 824 to 1,111 plans. The steepest increase was among plans offering in-home support services, with 794 plans providing this benefit in 2023 compared to less than 600 in 2022.

In-home support services include services that assist individuals with disabilities or medical conditions in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs) within the home.

The number of plans offering caregiver support services almost tripled from 2021 to 2023, reaching 259. This support consists of respite care provided through a personal care attendant or short-term institutional-based care.

The prevalence of home-based palliative care and therapeutic massage also grew from 2021, with a respective 149 and 163 plans offering these benefits in 2023.

The plan prevalence of each expanded benefit has grown every year since 2019, except for the therapeutic massage benefit between 2020 and 2021 and the adult day health services from 2021 to 2023.

The number of plans offering at least three of the supplemental benefits decreased from 2020 to 2021 but increased from five plans in 2022 to 25 plans in 2023, the brief noted.

“This research shows just some of the ways Medicare Advantage delivers the whole-person care seniors expect and deserve,” Mary Beth Donahue, president and chief executive officer of BMA, said in a press release. “As seniors contend with rising household costs, their ability to access more benefits that are built into the affordable cost of their Medicare Advantage plan is welcome news.”

In addition to being the supplemental benefit offered by the highest number of plans, the in-home support services benefit is the most widely available expanded supplemental benefit on a geographical scale, with 42 states providing it in 2023.

Twenty-one states offer therapeutic massages and support for caregivers, while 16 states offer home-based palliative care. Adult day health services are available in just two states—Arizona and California—with only 35 plans offering the benefit.

Medicare Advantage’s popularity has been rising in recent years, partly due to the program’s supplemental benefits.

The Commonwealth Fund found that Medicare beneficiaries 65 and older typically chose Medicare Advantage over traditional Medicare due to its enhanced benefits and out-of-pocket cost limits. For example, 24 percent of older beneficiaries reported choosing the private program for its additional benefits, such as vision and dental coverage.

CMS expanded the flexibility of supplemental benefits further in 2019 when it allowed Medicare Advantage plans to offer special supplemental benefits for the chronically ill (SSBCI). A past brief commissioned by BMA found that the number of plans providing SSBCI benefits increased by 38 percent between 2021 and 2022, rising from 815 to 1,127 plans.

However, Medicare Advantage plans may be lagging in the social determinants of health space. Recent data revealed that less than half of Medicare Advantage and dual eligible special needs plans (D-SNPs) offered nonmedical supplemental benefits for dual eligible beneficiaries.