Sharp Rise in Ancillary Medicare Advantage Benefits — from Adult Day to Home Care — Coming in 2020

Medicare Advantage plans are rapidly expanding the supplemental benefits recently approved by the federal government, with 116 plans offering more than one of these services for the 2020 contract year. Those supplemental benefits provide more options for care at home for beneficiaries — and could potentially represent paths away from the skilled nursing setting.

In 2019, by comparison, none of the plans offered more than one of these benefits in 2019, according to a new report from the actuarial consulting firm Milliman that was commissioned by the Better Medicare Alliance (BMA).

In April 2018, the Centers for Medicare & Medicaid Services allowed Medicare Advantage (MA) plans to offer non-skilled, in-home care services, marking the first time the agency allowed supplemental benefits in MA that include assistance with daily maintenance tasks. In 2019, CMS then expanded the flexibility by allowing MA plans to provide supplemental benefits for those with chronic illnesses, the Milliman report noted.

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The 2019 announcement expanded the scope of “primarily health related” supplemental benefits, allowing MA plans to offer an entire host of additional benefits as long as they were related to health care, the Milliman report said.

The number of plans offering adult day health services and in-home support services spiked sharply between contract years 2019 and 2020, the report found. In the contract year 2020, 64 plans will offer adult day services, compared with zero in the 2019 contract year. While 51 plans offered in-home support services in 2019, that number is set to jump to 148 in the next contract year.

Source: Milliman/Better Medicare Alliance

The findings highlight the different ways Medicare Advantage plans can keep patients in the home and provide services outside of traditional institutional settings.

Adult day services are a particularly notable example, since they represent a middle ground between home care and institutional care — and could be competitors to skilled nursing facilities for residents who require long-term services and supports.

The number of adult day providers has doubled in the past six years alone, Centennial Adultcare Center CEO William Zagorski noted in a June presentation at the Healthcare Innovation and Investment Conference (HI2) in Chicago.

“I think in the next five to seven years, you’ll see that adult day services are an absolutely essential and integral part of the long-term care continuum — between the value-based design and the reimbursement models,” he said at the time.

In addition to promoting independence and providing a respite for caregivers, the adult day setting has another advantage that may prove attractive to regulators and plans: lower cost.

“Adult day still remains the lowest-cost long-term care option. It’s about 50% less or more,” Zagorski said back in June. “The value has been there. It’s been demonstrated.”

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