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

Medicare Advantage plans will be more attractive than ever in the upcoming Annual Election Period beginning in October, predicts Patrick Phillips, CEO of Cavulus, a Pittsburgh, Pa.-based technology firm which specializes in the Medicare industry.

“Our technology platform is utilized by Medicare Advantage plans of all sizes across the country, so we always have a pulse on industry trends explains Phillips. “This enrollment season, I expect to see numerous new and uniquely expanded benefits.”

The Centers for Medicare & Medicaid Services (CMS) responsible for regulating Medicare Advantage (MA), recently eased rules regarding health-related supplemental benefits. As Phillips points out, unlike original Medicare, private plans proactively manage medical costs and are obligated to reinvest savings into benefits. The loosening of benefit rules empowers MA plans to be more creative.

Cavulus CEO Patrick Phillips

Historically, MA plans include additional benefits such as vision, dental, gym membership and travel. But Phillips forecasts benefits and services emerging that will have meaningful value and address skyrocketing healthcare costs.

He cites Anthem’s “Essential Extras” as an example of enhanced benefit packages that consumers will encounter more commonly. These include home meal deliveries, personal home helpers, and alternative medicines like acupuncture and massage that have been embraced by baby boomers aging into Medicare.

Cavulus CTO Richard Nugen further notes how new benefit designs are attracting tech companies and collaboration that may not have been expected in the MA industry.

“Companies like Lyft are being utilized for transportation benefits.” In a recent Forbes article, Lyft’s vice president of healthcare Megan Callahan said, “We expect to be working with the majority of the largest MA plans by 2020.”

Phillips views new benefits as an alignment with the true aim of healthcare. “The goal is wellness and preventive care versus acute care and treating someone once they’re sick,” he said. He recommends to Medicare beneficiaries shopping this fall to “dig deeper than comparing just cost, network and pharmacy needs, and to investigate plans which offer expanded benefits that you might utilize the most.”

About Cavulus:Cavulus is a technology driven specialist in Medicare Advantage insurance solutions. The Cavulus Cloud-based Medicare Advantage Platform (Cavulus MAP™) unifies marketing, sales and enrollment operations, and is utilized by many of America’s top insurers, including several BlueCross/ BlueShield companies, UPMC Health Plan, SCAN Health Plan, John Hopkins Healthcare, Lumeris and United Healthcare. For details visit www.cavulus.com.

7 COMMENTS

  1. 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

  2. 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

    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

  3. 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.

  4. vic120

    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.

  5. 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.

  6. Lionheart

    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?

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