Anthem expanding access to MA benefits targeting social determinants in 2021

Anthem headquarters
Anthem offers a look at its Medicare Advantage plans for 2021. (Anthem)

Anthem and its affiliated health plans are putting a focus on expanding their slate of programs targeting the social determinants of health to reach members in more geographies for the 2021 plan year.

Martin Esquivel, vice president of Medicare product management at Anthem, told Fierce Healthcare that over the past year the insurer has grown the number of plans offering such benefits by 50%.

"That was an important component for us," Esquivel said.


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Anthem is also increasing the number of counties in which it offers a Medicare Advantage (MA) plan by 20% and will enter Iowa for the first time. It will also cover all counties in Tennessee and Kentucky for 2021.

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The COVID-19 pandemic opened the door for new flexibilities around these supplemental benefits, Esquivel said. For example, if a member had chosen an adult day care benefit, they were given the chance to switch to something that would be more valuable to them amid social distancing.

Transportation was another benefit that members were given the opportunity to switch from under the pandemic, as they were not as likely to be traveling out of their homes to avoid spreading or catching the virus, he said.

"The good news is that we were pretty well prepared for the pandemic in terms of the types of benefits that we offer," Esquivel said. "What we did is within the social determinants benefit we made sure that access to a selected benefit wasn’t hampered by the pandemic."

The pandemic also put a spotlight on the insurer's community resource teams, both in terms of the work they did in educating members about their benefit options and also the way they could identify other social needs that could be addressed, he said.

Esquivel said there are a slew of examples of these teams identifying critical issues across Anthem's MA membership, such as a scenario where the insurer was able to intervene for a member living in a home infested with black mold.

RELATED: Insurers offered new benefits in response to COVID-19. Where do they stand 6 months later?

Anthem also already offered telehealth benefits for its Medicare members, but the pandemic emphasized the need to ensure beneficiaries are aware of these options and take advantage of them, he said.

Anthem will offer telehealth visits for in-network providers at $0 through the end of the year. 

"What the pandemic did was really fast-track how the world adopted this technology and making sure or ensuring that our members had access to telehealth services primarily through their PCP or medical group was the best way that we could ensure continuity in the services being provided," Esquivel said.

With open enrollment on the horizon, Esquivel said he is seeing the benefit offerings in MA continue to grow across the industry. This market line is growing business for a number of insurers both at the national and regional levels, particularly as baby boomers continue to age into Medicare.

Esquivel said the competition is ultimately good for seniors, who have plenty of choices to ensure they're selecting the Medicare coverage that best meets their needs.

"The industry has kept up," he said. "I think that is only a good thing for the consumer."

Medicare open enrollment begins Oct. 15.