CMS announces big expansion to Medicare Advantage value-based insurance design model

Health insurance benefits form
CMS will allow insurers to propose their own systems or methods for identifying eligible enrollees for the Medicare Advantage value-based insurance design model. (Getty/michaelquirk)

In 2019, the federal government will expand the Medicare Advantage value-based insurance design model to an additional 15 states and broaden the options available for participants.

The changes, announced Wednesday by the Centers for Medicare & Medicaid Services, will make the V-BID model operational in a total of 25 states.

The Obama administration debuted the demonstration project back in 2015, initially involving seven states. The goal was to provide MA plans the flexibility to offer custom-designed supplementary benefits for beneficiaries with specific conditions such as hypertension, diabetes and congestive heart failure. Last year, CMS announced that it would expand the model to three more states in 2018.

Now the Trump administration is not only expanding the model geographically, but adding in even more flexibility for plans. For one, CMS said that starting in 2019, Chronic Condition Special Needs Plans will be able to participate.

The agency will also allow insurers to propose their own systems or methods for identifying eligible enrollees—potentially including Medicare beneficiaries with different chronic conditions than those previously established by CMS.

“This administration is committed to making sure that our seniors have more choices and lower premiums in their Medicare Advantage plans,” CMS Administrator Seema Verma said in the release. “CMS expects that this demonstration will provide insights into future innovations for the Medicare Advantage program.”

Tuesday’s announcement is just the latest in a series of moves from CMS that are aimed at elevating the role of Medicare Advantage. It has already issued a final rule that would allow MA to be included in advanced alternative payment models, and a proposed rule that eases regulations and promotes more flexibility for the privately run Medicare plans.