CMS Updates and Expands Medicare Advantage Value-Based Insurance Design Model for 2019

December 6, 2017

The Centers for Medicare & Medicaid Services (CMS) have announced several updates to the Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019.  The updates are meant to encourage customized benefit designs and provide flexibility to meet the health needs of beneficiaries in a total of 25 states.

In the Medicare Advantage and Part D proposed rule, CMS 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.

Beginning in 2019, the VBID model will expand to an additional fifteen 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.

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.

For more information on VBID Model and the CY 2019 Request for Applications, please visit: https://innovation.cms.gov/initiatives/VBID/

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