CMS Cans Costly Medicare Advantage VBID Model, Sparking Concerns About Duals
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Dec 19, 2024
Citing “substantial and unmitigable costs” that were driven partly by increased risk scores, CMS on Dec. 16 said it was shutting down the Medicare Advantage Value-Based Insurance Design (VBID) model at the end of 2025. The surprise move takes away MA plans’ primary method of offering reduced Part D cost sharing and raises questions about the stability of benefits for dual eligibles, since half of participating plans are Dual Eligible Special Needs Plans (D-SNPs).
CMS first tested the model on a limited basis in 2017, allowing sponsors to offer reduced cost sharing for medications and offer high-value services to beneficiaries with select chronic conditions. Phase II of the model, launched in 2020, extended it to all states and territories and allowed all types of Special Needs Plans to participate. Model enhancements included permitting insurers to condition benefits on socioeconomic status (SES) and offering additional supplemental benefits, including non-primarily health-related benefits such as non-medical transportation and food and produce.
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