Medicare Advantage and Medicaid Plans Step Up to Address the SDoH

Original story posted on: October 7, 2020

Medicare Advantage beneficiaries will have wider access to plan choices. 

With COVID-19 impacting every population, especially older and at-risk adults, payers are taking a critical look at what benefits would be an asset for the future. Opportunities exist to enhance coverage for these populations, with lots of action set for 2021. Let’s review those happenings in the area of the social determinants of health (SDoH), particularly for Medicare Advantage (MA) and Medicaid Plans:

  • First, a majority of managed care providers were set to allow cost-sharing waivers for telehealth visits of non-COVID-19 needs to expire on Sept. 30 for individual and fully insured health plans. So much for that:
    • Aetna, UnitedHealthcare, and Cigna will allow telehealth and virtual visits to continue with no cost-sharing for Medicare Advantage and Medicaid members through the end of 2020; and
    • A total of 94 percent of the MA plans will ramp up telehealth benefits.
  • Cigna is expanding Medicare Advantage plans into five additional states: Ohio, Virginia, Oklahoma, Utah, and New Mexico, marking a 22-percent increase in the payer’s county footprint from 2020. Coverage will be span 369 counties in 23 states for 2021.
    • Cigna will also expand preferred provider organization offerings in 154 counties;
    • Behavioral health visits via audio or video will be allowed, at no cost; and
    • Virtual physical therapy will be provided and reimbursed for in-home treatment.
  • Medicare Advantage beneficiaries will have wider access to plan choices overall, with premiums dropping to the lowest point in 14 years.
    • For example, beneficiaries with diabetes will have access to > 1,600 Medicare Advantage and Part D prescription drug plans. All plans will offer insulin for a co-pay of $35 per month in 2021.
  • Chronic diseases are costly enough, with COVID-19 and COVID-related stress only exacerbating these conditions.
    • Some 500 MA plans will offer lower co-pays or supplemental benefits to enrollees with chronic diseases and other conditions.
  • Last week on Monitor Mondays, I reported challenges with food insecurity. As the pandemic continues, attention to nutrition, especially for MA beneficiaries, is a mandate.
    • More than 900 plans will offer benefits, such as meal delivery.
  • A total of 730 plans will ensure coverage of:
  • In-home support;
  • Therapeutic massage;
  • Adult day health services;
  • Palliative care; and
  • Integrated hospice

Finally, rural communities will have an 18-percent increase in MA plans in 2021, up from 2,450 plans to 2,900 plans.  Remember, more than 50 percent of readmissions are due to the SDoH. Know how much these benefit changes have the potential to impact Medicare and Medicaid beneficiaries and their health outcomes, as well as the bottom lines of healthcare organizations caring for them, not to mention my case management colleagues intervening on their behalf.

Everyone will be watching for the true impact of these benefit changes on all stakeholders. For now, we checked in with the Monitor Mondays audience through our weekly survey to get their impressions on the potential impact of these changes, with the results available here.

Programming Note: Ellen Fink-Samnick, a member of the RACmonitor editorial board, is a permanent panelist on Monitor Mondays. Listen to her live reporting on SDoH every Monday at 10 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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