Medicare Advantage

As part of the Value-Based Insurance Design (VBID) model for CY2020, CMS has announced plans to begin offering hospice services under its Medicare Advantage plans beginning in 2021. Currently, patients must revoke the original Medicare (fee-for-service) benefit, including Medicare Advantage, and elect the Medicare Hospice Benefit to receive reimbursement for hospice services.

Experts in the industry, including the National Association for Home Care and Hospice (NAHC), have expressed concerns that offering Hospice reimbursement under Medicare Advantage plans may limit the benefits patients currently receive under the Hospice Benefit. This is because Medicare Advantage plans focus on reducing costs and often do not provide the same level of coverage that patients under the Medicare fee-for-service plan receive.

Through the Value-Based Insurance Design (VBID) Model, CMS is testing a variety of Medicare Advantage health plan innovations designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries, including those with low incomes such as dual-eligibles, and improve the coordination and efficiency of health care service delivery.

The VBID Model began January 1, 2017 and has been extended to run through 2024. While the VBID model began with seven states in 2017, additional states have been added each year. The Bipartisan Budget Act of 2018 requires expansion of VBID into all 50 states and territories by 2020.