2024 AEP Insight Series: Report 7 📊

Analyzing SSBCI Trends: A Comprehensive Analysis of Medicare Advantage Plans

November 16, 2023 Market Research

The concept of Special Supplemental Benefits for the Chronically Ill (SSBCI) was introduced to provide additional flexibility for Medicare Advantage (MA) plans to offer a broader range of supplemental benefits to beneficiaries with certain chronic illnesses, enhancing the quality of care and improving the overall health of those with chronic conditions. These benefits can include services not typically covered by Medicare, such as Non-Medical (NM) Transportation, Home Modifications, Meal Beyond, Food Produce, General Support, Social Needs Quality, Indoor Air Quality, Services Supporting Self-Direction, Complementary Therapies, and Pest control, all aimed at improving the health and well-being of individuals with chronic conditions.

For this analysis, we’ve utilized 2024 data published by CMS, including the Landscape, Crosswalk, and Plan Benefit Package (PBP) files, to identify the different SSBCI trends for Non-SNP plans, with cuts by HMO and PPO. The analysis also provides insights into premium segments impacting various benefits.

Overview of SSBCI benefits:

Unlike Supplemental and Enhanced benefits, the inclusion of SSBCI in plans is relatively low. The most widely covered SSBCI is Food Produce, which has seen a significant increase from 1.8% inclusion in 2020 to 14.5% in 2024, although with a minimal of 9% Year-over-Year (YoY) growth compared to previous years. Apart from Food Produce and General Support, all the remaining benefits have observed a declining trend in total plans offered. However, for new plans, alongside Food Produce and General Support, NM Transport has also seen an increase, while others have decreased.

The Social Needs Quality benefit saw a decline in plan count for the first time by losing the highest number of plans (92) among other SSBCI in 2024. Furthermore, the Indoor Air Quality benefit showed a fluctuation in plan coverage, decreasing from 2.5% in 2021 to 1.9% in 2022, rebounding to 175 (4%) plans in 2023, but then experienced a decline in 2024, losing 73 plans, the second-highest reduction among all benefits.

The Meal Beyond benefit experienced a 27% YoY drop in the total plan offerings next year, and the coverage in new plans has been consistently decreasing since 2022. Additionally, Pest control benefits, which were provided in 207 plans in 2023, decreased to 158 in 2024, with new plans also following the same trend by decreasing from 32 to 19 plans in the same period. On top of that, Services Supporting Self-Direction, Complementary Therapies, and Home Modification benefits all have coverage of less than 2% of total Non-SNP plans, and there are no new plans for Home Modification.

Also Read – Medicare Advantage Premium Tiers: Impact on Supplemental and Enhanced Benefits

HMO

Although there has been a reduction in the total number of HMO plans, the percentage of plans that provide Food Produce (19%) and General Support (10%) has experienced an increase of 2.4% and 0.4%, respectively. On the other hand, the rest of the benefits saw a decrease in offering, and the most notable decreases were found in Meal Beyond and Social Needs Quality, each experiencing a decline of 2%.

Examining the finer details, the inclusion of Food Produce in renewal and new HMO plans has experienced an increase of 27 and 14 plans, respectively, equivalent to a 7.3% YoY in renewal and a 25% YoY rise in new HMO plans. All other benefits have witnessed a decrease in 2024, with Meal Beyond (-51 total plans), Pest Control (-32 plans), and Home Modifications (-19 plans) having seen consecutive declines over the past two years.

Notably, General Support, which had the most significant increase of 117 renewal plans in 2023, saw a decrease of 2 plans in 2024, now totaling 218 plans, while only three new plans added this benefit. Conversely, the most substantial decrease in new plan offerings was observed for Social Needs Quality, which declined by 13 plans, and Indoor Air Quality, which saw a reduction of 9 plans.

PPO

In 2024, PPOs, like HMOs, witnessed a minor expansion in plan coverage for Food Produce and General Support, comprising 9% and 5% of total plans, respectively. Furthermore, NM Transport also exhibited a slight increase in coverage, accounting for 4% of all PPO plans. On the flip side, there was a 2% reduction in the percentage of plans offering Social Needs Quality, Indoor Air Quality, and Complementary Therapies.

The inclusion of General Support in renewal PPOs experienced a significant uptick in 2023, with an additional offering in 34 plans, and in 2024, it saw a slight rise of 9 plans. A comparable trend was seen in both NM Transport and Food Produce, which saw a YoY increase of 11% and 9%, respectively, in 2024. While, Indoor Air Quality, Services Supporting Self-Direction, Meal Beyond, and Pest Control also had a significant rise in 2023, each saw a loss in 2024 by 23, 16, 15, and 9 plans respectively. On the other hand, the offering of Home Modification in renewal PPOs has seen a continuous decrease over the years.

In the case of new PPOs, General Support was boosted by 11 plans, followed by NM Transport (+5) and Food Produce (+3). None of the new PPOs included Complementary Therapies, Home Modifications, and Services Supporting Self-Direction. Conversely, several other SSBCI witnessed a decline in the number of new plans featuring them, particularly Meal Beyond was the most extensively offered benefit in 2021 with 33 new plans, but its availability in new plans has steadily decreased, with only 7 offering it next year.

Zero-Premium prominence with SSBCI (Only total Non-SNP plans):

Over 80% of plans that offer SSBCI fall into the zero-premium segment, primarily driven by Complementary Therapies (85% are zero-premium plans) and Home Modifications (80% are zero-premium plans), along with Pest Control, Social Needs Quality, and Services Supporting Self-Direction, each around 82%. Despite the higher percentage offered in these benefits, there has been a notable decrease in the number of plans available in 2024 compared to the previous year. However, the lowest proportion within this segment is observed for Meal Beyond, with only 56% of plans offering this benefit being zero-premium, and all other benefits falling within this range but not exceeding 85%.

Conclusion:

In summary, the analysis of SSBCI trends within Medicare Advantage plans reveals dynamic shifts in the inclusion of these benefits. While the Non-SNP, HMO, and PPO plans have seen a notable rise in the coverage of Food Produce and General Support, there have been fluctuations and declines in other SSBCI, mainly in Social Needs Quality. The premium segmentation analysis highlights that many SSBCI are prominently offered in the zero-premium segment, with variations across different premium segments. Notably, Meal Beyond and Food Produce have displayed varying trends across premium segments, reflecting the complex landscape of SSBCI within Medicare Advantage plans.