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CMS updates Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019

CMS updates Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019
Expansion of model to 25 total states to provide Medicare beneficiaries with more choices and lower costs

The Centers for Medicare & Medicaid Services (CMS) today announced several updates to the Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019 that encourages customized benefit designs and flexibilities that meet the health needs of beneficiaries in a total of 25 states.

“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.” 

CMS recently announced in the Medicare Advantage and Part D proposed rule that it is providing new flexibility for customized benefit designs that address the specific health needs of certain beneficiaries under Medicare Advantage. This allows additional plan variety and options, reduced cost sharing for customized benefits and different cost-sharing for beneficiaries that meet specific medical criteria.

Medicare Advantage provides Medicare beneficiaries with choices and options that meet their unique health and financial needs. It remains a popular choice among beneficiaries and has high beneficiary satisfaction. Enrollment in Medicare Advantage is at an all-time high as approximately one-third of Medicare beneficiaries are in a Medicare Advantage plan. The number of Medicare Advantage plans available for individuals to choose from across the country is increasing from about 2,700 in 2017 to more than 3,100 in 2018 – and more than 85 percent of Medicare beneficiaries will have access to 10 or more Medicare Advantage plan choices in 2018.

Beginning in 2019, the VBID model will expand to an additional fifteen new states for a total of 25 states, allow Chronic Condition Special Needs Plans to participate, and allow participants to propose their own systems or methods for identifying eligible enrollees. This change will afford participants with the opportunity to include Medicare beneficiaries with different chronic conditions than those previously established by CMS -- such as lower back pain, chronic kidney disease, obesity/pre-diabetes, asthma, and tobacco use. This will provide beneficiaries across 25 states with new choices and access to customized care.

For 2018, CMS allowed Medicare Advantage plans in the following ten states to apply to the model: Alabama, Arizona, Indiana, Iowa, Massachusetts, Michigan, Oregon, Pennsylvania, Tennessee, and Texas. For 2019, CMS will include fifteen more states in the model: California, Colorado, Florida, Georgia, Hawaii, Maine, Minnesota, Montana, New Jersey, New Mexico, North Carolina, North Dakota, South Dakota, Virginia, and West Virginia. 

Medicare Advantage Organizations that wish to participate in 2019 can access the Request for Applications now and applications will be due on January 26, 2018 at 5pm EST. Newly interested organizations may apply and existing participants must reapply for participation in 2019.

For more information on VBID Model and the CY 2019 Request for Applications, please visit: