2024 AEP Insight Series: Report 5 📊

Supplemental and Enhanced Benefits: Trends and Transformations of Dual-Eligible Special Needs Plans

October 25, 2023 Market Research

This comprehensive analysis delves into the landscape of Supplemental and Enhanced Benefits offered by Dual Eligible Special Needs Plans (D-SNP), categorically exploring the trends of HMOs and PPOs.

The report uncovers patterns, shifts, and noteworthy insights concerning the availability and evolution of these benefits, highlighting the significant changes observed in plan coverage, both for total and new plan offerings. This examination aims to provide a profound understanding of the current state of different benefits within D-SNP plans and their influence on the healthcare landscape. The insights in this report are derived from the Landscape, Crosswalk, and PBP files published by CMS prior to the 2024 Annual Enrollment Period (AEP).

Supplemental benefits:

In D-SNP plans, the Enhanced Benefit stands out as the foremost Supplemental Benefit, available in 98% of plans, slightly lower than the 99% of plans last year. Following closely are Eye Wear at 97%, Over-the-Counter (OTC) at 96%, and Dental Comprehensive at 95%, which have seen an increase in the percentage of plans available for the upcoming year. Cardiac benefits are only available in one plan introduced this year, and Skilled Nursing Facility (SNF) benefits have not been included in any plans since 2021.

Except for Psychiatry, which has experienced a reduction in the number of plans offered by 10% year-over-year (YoY), all other Supplemental Benefits increased in availability. The most remarkable increase was seen in the plans providing Physical Exam, with a YoY growth of 27%. Nevertheless, compared to previous years, the increase in 2024 is relatively moderate, suggesting a more conservative year for Payors. It’s worth noting that plans offering OTC benefits fell by 1.4% in 2023 but significantly recovered in 2024, with an increase of 145 plans, indicating a 21% YoY growth.

Hearing Exam, Hearing Aids, Eye Wear, Eye Exam, Enhanced Benefits, Emergency, and Dental Comprehensive are offered as Supplemental Benefits in approximately 98% of the new 2024 D-SNP plans. However, the number of new plans offering Inpatient Hospital benefits has notably decreased by 21% YoY. Similarly, Meal, Transport, Enhanced Benefits, and Hearing Exam have experienced a marginal decline, each with less than a 5% YoY reduction.

In contrast, Hearing Aids, Eye Wear, Eye Exam, Dental Comprehensive, Outpatient Blood benefits, and Dental Preventive benefits have experienced a decline in 2023 but remained static in 2024. Interestingly, new D-SNP plans offering OTC followed the same pattern as total D-SNP, which declined by 13% YoY in 2023 and saw some recovery in 2024 by 6% YoY with an increase of 7 plans. On a positive note, Acupuncture has seen the most significant growth, with 13 additional plans offering it at a rate of 28% YoY.

Also Read – Supplemental and Enhanced Benefits Medicare Advantage Plans: Trends and Transformations of the Non-SNP Market

HMO Plans

With 84% of D-SNP plans falling under the HMO plan type, the availability of various Supplemental benefits trends are generally parallel. Notably, Enhanced Benefits, Eye Wear, and OTC stand out as the top three benefits provided within the HMO plan type, while Cardiac benefits are only available in one plan, and SNF benefits are not offered in any of the plans.

Except for Psychiatry, the availability of all other benefits has demonstrated an upward trend. The most significant increase was witnessed in Physical Exam, with an additional 110 plans, followed by OTC, with 91 additional plans. The availability of Chiropractors remained constant at 313 plans. All other benefits experienced a growth rate of less than 10% YoY.

Each Supplemental benefit saw an increase in the number of new HMO plans offered, with Acupuncture showing the most substantial growth at a rate of 52% YoY. However, Inpatient Hospital was the outlier, witnessing a significant 24% YoY drop in plan offerings.

PPO Plans

Ninety-nine percent of total PPO plans offer Dental Preventive, Enhanced Benefits, Eye Exam, Eye Wear, and OTC as Supplemental benefits. Unsurprisingly, neither Cardiac nor SNF benefits have been available in any PPO plans.

The number of plans offering Supplemental benefits has been steadily rising over the years; however, the rate of increase is below 50% compared to the growth rate seen in 2023, except for OTC benefits, which have tripled from 17% in 2023 to 66% YoY in 2024. The growth of OTC benefits was evident with 54 additional plans, followed by Physical Exam, which saw an increase of 45 plans, and Chiropractor benefits, which expanded by 17 plans. Around 72% of Supplemental benefits experienced YoY growth within the range of 20-25%.

In contrast to the overall PPO plans, the new PPO plans witnessed a substantial reduction in the availability of all Supplemental benefits, with an average annual decrease of 30%. It’s worth mentioning that none of the new PPO plans include coverage for Psychiatry services.

Enhanced benefits:

In 2024, D-SNP comprises 15% of total plans, with Fitness Benefit consistently included in over 90% of all D-SNP plans since 2022, followed by Remote Access Technologies (76%) and Personal Emergency Response System (PERS) (59%). Aside from Wigs for Hair Loss Related to Chemotherapy (20%), In-Home Support Services (22%), Nutritional/Dietary Benefits (27%), Bathroom Safety Devices (32%), Health Education (36%), and Additional Sessions of Smoking and Tobacco Cessation Counseling (41%), other remaining benefits inclusion in D-SNP plans remains below the 10% mark.

Bathroom Safety Devices and Fitness are the most included benefits in 2024, with a notable addition of 159 and 60 plans, respectively. Other benefits that noticed a significant YoY increase in coverage are Medical Nutrition Therapy (MNT) (52%), In-Home Safety Assessment (25%), Therapeutic Massage (24%), and Wigs for Hair Loss Related to Chemotherapy (22%). Interestingly, Telemonitoring services have held steady, maintaining the same level of inclusion as the previous year. Contrastingly, Enhanced Disease Management (31% YoY), In-Home Support Services (32%), and Counseling Service (41%) benefits noticed a substantial YoY decline in total plan coverage.

The inclusion of benefits in new plans reveals intriguing disparities compared to their presence in total plans; the Fitness benefit experienced a modest decline, with just a single plan dropping off, while Remote Access Technologies saw a slight dip from 107 to 102 plans. Nevertheless, when we delve deeper into the spectrum of benefits, Additional Sessions of Smoking and Tobacco Cessation Counseling, Bathroom Safety Devices, Wigs for Hair Loss Related to Chemotherapy, MNT, and Therapeutic Massage showed growth, but the trajectory for all other benefits indicates a declining trend in new plan incorporation.

Notably, PERS, In-Home Support Services, and the Weight Management Program experienced the most significant decline, losing 20, 14, and 7 plans, respectively. Alternatively, Post-discharge In-Home Medication Reconciliation, Home-Based Palliative Care, and Adult Day Health Services stand out with no new plan offerings.

HMO Plans

Mirroring the nationwide trend, the domain of D-SNP HMO plans upholds a similar pattern that Fitness reigns supreme, offered in 93% of plans, while Remote Access Technology follows at 77%, and PERS maintains at 58%. All other benefits are included in 40% of plans or less. Furthermore, 109 additional plans will provide Bathroom Safety Services in 2024 with a 91% YoY increase, followed by MNT with a 49% YoY increase. In terms of absolute difference in plan count, In-Home Support Services underwent a fluctuating journey in the provision of benefits. The number of plans added to this service until 2022 was less compared to 2020, but saw a resurgence in 2023, and once again faced a dip of 86 plans in the current year. PERS also observed a reduction, moving from 446 to 425 total plans.

The pattern of Fitness benefits is interesting; the coverage of new plans dropped from 107 in 2022 to 89 in 2023, which recovered to 101 plans in the next year. On the other hand, the number of new plans in PERS is unchanged as of 2023, and Remote Access Technology has increased. About 50% of the benefits noticed a downward trend in coverage of new plans; the highest was seen in Health Education, losing 11 plans with a 21% YoY decline.

PPO Plans

Out of 22 enhanced benefits, around 14 are offered in the D-SNP PPO plan category. In terms of total plan coverage, only In-Home Support Services and PERS experienced declines in 2024, with a 15% and 11% YoY decrease, respectively. The most significant increase was noted in Bathroom Safety Devices, rising from 3 to 50 plans, followed by Fitness and Remote Access Technologies with approximately 20% YoY growth, though slightly less than in previous years.

The inclusion percentage in new plans stands at 96% for Fitness, slightly lower than in 2023. Meanwhile, Remote Access Technology saw a significant drop from 88% to 68%, and PERS decreased from 95% to 68%. Wigs for Hair Loss Related to Chemotherapy and Health Education benefits increased their plan coverage, while Fitness, Remote Access Technologies, and PERS saw gradual declines of 33%, 47%, and 51% YoY, respectively. In-Home Support Services and Nutritional/Dietary Benefits also experienced a decrease by losing eight plans each.

Conclusion:

In conclusion, this analysis illuminates the intricate dynamics of Supplemental Benefits within D-SNP plans, revealing the resilience and adaptation of these offerings in response to changing healthcare demands. The trends across Enhanced benefits in HMO and PPO plans underscore the evolving preferences of beneficiaries and the strategic choices made by Payors. The variations in the availability and utilization of these benefits reflect a complex interplay of factors in the healthcare industry. As we move forward, staying attuned to these trends and understanding their implications will be vital for healthcare stakeholders in providing the best possible care and support for Medicare beneficiaries.