supplemental benefits

Medicare Advantage (MA) plans have gained flexibility to offer a wide range of new supplemental benefits and to target benefits to members with specific conditions and individual need. This data insight provides an analysis of non-medical supplemental benefit growth since 2020, and focuses on the following: Special Supplemental Benefits for the Chronically Ill (SSBCI), which first became available in 2020 through the passage of the CHRONIC Care Act and a set of five Expanded Primarily Health-Related Benefits (EPHRB), which first became available in 2019 after the Centers for Medicare and Medicaid Services (CMS) expanded the definition of what could be considered “primarily health-related."

This report, written by RTI International and the Center for Health Care Strategies, combines information gathered from an environmental scan and case studies to provide an overview of the current landscape of Medicare Advantage Organizations (MAOs) that provide expanded supplemental benefits. It includes their initial experiences and challenges with developing and administering the benefits to their members.

The Urban Institute conducted a series of interviews with Medicare Advantage plans, Medicare Advantage experts, and social service providers to better understand how health plans were responding to CMS’s new flexibility with regards to supplemental benefits. This report presents the findings from these interviews. It also explores possible policy changes to further support supplemental benefits and describes what funding and resources are available for state to administer these benefits.