Prediction: Eased value-added rules for Medicare Advantage will boost fall enrollment

[Insurance Forums Staff]

Insurance Forums Staff submitted a new article

Prediction: Eased value-added rules for Medicare Advantage will boost fall enrollment

Cavulus CEO Patrick Phillips predicts new and uniquely expanded benefits in wake of CMS recently easing supplemental health benefits rules

Continue reading the Original Article.

 

[somarco]

Value-Added Items and Services (VAIS) are items and services that are not plan benefits,
are not part of the MAO plan’s benefit package and may not be marketed to prospective
enrollees, or used as an inducement or incentive for enrollment. VAIS are non-Medicare
covered services or items, typically discounts, offered by a VAIS provider to the
enrollees of an MA plan. The plan may choose to facilitate access for its enrollees to the
VAIS by acting on behalf of the VAIS provider by performing certain administrative
activities, such as notifying enrollees about the VAIS or verifying enrollee membership
in the plan.

Thus, the MAO incurs either no cost for facilitating enrollees’ access to the VAIS, or the
costs are solely administrative. Solely administrative costs are defined as those required
to administer the plan’s facilitation of enrollee access to the VAIS, e.g., clerical items or
equipment and supplies related to communication about the VAIS (such as phone and
postage) or database administration (such as verifying enrollment or tracking utilization).
Minimal cost, in and of itself, does not qualify a cost as being “solely administrative.”

It is important to note the following:
• Plan enrollees who choose to obtain VAIS items or services are responsible for all
costs.
• Any notification a plan sends to its enrollees about the availability of VAIS must
include a disclaimer explaining that the VAIS is not a plan benefit.
• MAOs may not include VAIS in any marketing materials.
• VAIS is not an alternative to a supplemental benefit. That is, if CMS determines that
a specific item or service for which the plan would incur more than administrative
cost, is not allowable as a supplemental benefit, the plan may not offer the item or
service as a VAIS.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c04.pdf

 

[Travis Price]

CMS? Who day?

 

[vic120]

Value-Added Items and Services (VAIS) are items and services that are not plan benefits,
are not part of the MAO plan’s benefit package and may not be marketed to prospective
enrollees, or used as an inducement or incentive for enrollment. VAIS are non-Medicare
covered services or items, typically discounts, offered by a VAIS provider to the
enrollees of an MA plan. The plan may choose to facilitate access for its enrollees to the
VAIS by acting on behalf of the VAIS provider by performing certain administrative
activities, such as notifying enrollees about the VAIS or verifying enrollee membership
in the plan.

Thus, the MAO incurs either no cost for facilitating enrollees’ access to the VAIS, or the
costs are solely administrative. Solely administrative costs are defined as those required
to administer the plan’s facilitation of enrollee access to the VAIS, e.g., clerical items or
equipment and supplies related to communication about the VAIS (such as phone and
postage) or database administration (such as verifying enrollment or tracking utilization).
Minimal cost, in and of itself, does not qualify a cost as being “solely administrative.”

It is important to note the following:
• Plan enrollees who choose to obtain VAIS items or services are responsible for all
costs.
• Any notification a plan sends to its enrollees about the availability of VAIS must
include a disclaimer explaining that the VAIS is not a plan benefit.
• MAOs may not include VAIS in any marketing materials.
• VAIS is not an alternative to a supplemental benefit. That is, if CMS determines that
a specific item or service for which the plan would incur more than administrative
cost, is not allowable as a supplemental benefit, the plan may not offer the item or
service as a VAIS.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c04.pdf

Yet the first thing many MA people want to know, Does it cover glasses Dental Gym membership

Its all in the SOB as well

Besides that it is in all the commercials Does your plan, have the dental and vision your intitled too yada yada

 

[Midlevel]

The additional benefits of MA plans is what really makes them attractive to clients. Doesn't hurt there usually isn't a premium either and includes the PDP. When I get a call about a $300 copay for a CT scan I always ask if they are using their dental, vision, OTC, gym membership, etc. When they remember they aren't paying a premium and have all these additional benefits the $300 seems like nothing.

 

[somarco]

Yet the first thing many MA people want to know, Does it cover glasses Dental Gym membership

Its all in the SOB as well

Besides that it is in all the commercials Does your plan, have the dental and vision your intitled too yada yada

I sold about 50 Anthem Medigap plans in the last 6 months of 2018 primarily because they had Silver Sneakers.

No, I did not use that as a lead in, but had quite a few folks who initiated the SS part of the conversation.

BURP/UHC still includes SS in their package here but I expect it will go away by 2020 or the year after. Dropping SS has created quite an uproar on the BURP forum.

Reading my earlier post, it seems that the Value Added Items and Services are merely DISCOUNTS facilitated by the MA carrier. The COST of the VAIS is borne by the covered participant. These are not reimbursable claims.

The carrier can provide literature explaining the VAIS but cannot use them as an inducement to buy their plan.

Of course we all know carriers and agents would NEVER say "If you buy THIS plan look at all the things that come with it"

Most of the discounts available to BURP members are available simply for asking for your "senior" discount at hotels, restaurants, etc.

 

[Lionheart]

Let's not confuse the difference between VAIS and plan benefits... D-V-H that is included in plan benefits are not considered VAIS, they are plan benefits. VAIS are items that cannot be discussed during the sales presentation, and plan benefits can be explained, like basic dental, vision and hearing benefits. Similarly, chiropractic and with some plans, acupuncture, are considered to be plan benefits, not VAIS. @somarco posted the VAIS rules, but the meat of this article is about plan benefit rules being loosened to allow more plan benefits vs VAIS. The home meal delivery is a great example, it is a plan benefit, not VAIS. Good article, good discussion.

 

[somarco]

plan benefit rules being loosened to allow more plan benefits vs VAIS. The home meal delivery is a great example, it is a plan benefit, not VAIS.

Since this is for MA plans only, I presume there will be "anointed" providers who agree to accept the payment schedule for plan benefits. Any idea what the approval process is for these folks, the time frame for them to get paid and what kind of hoops they must jump through to accept and participate in electronic claim filing? Will they be subject to HIPAA rules and record keeping like other providers?

And yes, my earlier post was about VAIS since that was the title of this thread. Is that a problem?

 

[SueNomie]

Everyone can thank the Trump administration for giving a ton more money to Medicare advantage plans...When the Democrats are in power Medicare advantage plans aren’t so pretty, when Republicans come into power...they give more money to MAPD plans Which makes them more attractive, and that’s just the facts.

 

[somarco]

Not everything is political . . . unless that's the only way you view things

Who started SS, Medicare, Medicaid . . .?

Hint.

It wasn't the Republicans.