Medicare Updates Value-Based Design for 2019


Twenty-five states can participate in value-based insurance designs for Medicare Advantage plans in 2019.

The Centers for Medicare & Medicaid Services (CMS) recently announced multiple updates to the Medicare Advantage Value-Based Insurance Design (VBID) model for 2019. These changes encourage personalized benefit designs and flexibility needed to meet the needs of beneficiaries, according to a press release.

The CMS recently proposed a Medicare Advantage and Part D rule that would increase flexibility for benefit designs to address specific health needs.

The new proposal would provide patients with more variety and options, while lowering cost-sharing for personalized benefits. The proposal would also implement different cost-sharing for patients that meet certain criteria, according to the release.

Medicare Advantage is popular among beneficiaries, with one-third of Medicare patients enrolled in these plans, according to the CMS. Medicare Advantage plans are also consistently highly rated by beneficiaries.

For 2018, the CMS authorized 10 states to apply the VBID model to their Medicare Advantage plans. In 2019, the VBID model will span to 15 new states, reaching 25 states in total. The changes will also allow Chronic Condition Special Needs Plans to participate in VBID.

The CMS reported that they will also take suggestions on novel models or systems for eligible patients, according to the release.

The aforementioned changes will allow beneficiaries with chronic conditions, such as lower back pain, chronic kidney disease, obesity, pre-diabetes, asthma, and tobacco use to participate in the program, according to the release. Previously, these patients were excluded from the VBID model.

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

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