Calendar Year 2024 Participation in the Medicare Advantage Value-Based Insurance Design Model: Innovating to Meet Person-Centered Needs

The Centers for Medicare & Medicaid Services (CMS) is announcing the Calendar Year (CY) 2024 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model. The estimated number of MA enrollees covered by the 69 MA organizations (MAOs) participating in the VBID Model in 2024 will increase by 47% in 2024 compared to 2023. These enrollees will potentially benefit from the additional supplemental benefits, reduced cost sharing, or enhanced rewards and incentives offered through the Model.

Through the VBID Model, CMS is testing a broad array of MA health plan innovations designed to enhance the quality of care for MA enrollees – notably those with low incomes, such as dually eligible enrollees in Medicare and Medicaid and those qualifying for the Low-Income Subsidy (LIS) Program – as well as to reduce costs for enrollees and the overall Medicare program. As part of the Model test, participating MA plans offer additional supplemental benefits, reduced co-payments, and/or rewards and incentives that are anticipated to improve health and health equity by meeting social needs – such as food, transportation, and housing. The Model provides additional flexibilities to participating MAOs to engage enrollees in improving their care by receiving high-value services or participating in health-related activities, and to reduce financial barriers to access.

CY 2024 VBID Model Participation

For CY 2024, VBID Model participation continued to build on the substantial growth seen in CY 2023 and CY 2022. For CY 2024, the VBID Model has 69 participating MAOs, up from 52 in 2023, 34 in 2022, and 19 in 2021. These 69 participating MAOs are testing the Model in 49 states, DC, and Puerto Rico through 1,528 plan benefit packages (PBPs), up from 1,367 PBPs participating in 49 states, DC, and Puerto Rico in 2023, and 1,014 PBPs participating in 49 states, DC, and Puerto Rico in 2022. A total of 12.4 million MA enrollees are projected to be enrolled in participating PBPs in 2024, an increase from approximately 9.2 million enrollees in 2023 and 7.5 million in 2022. Over 8.7 million enrollees are projected to be offered additional supplemental benefits, and/or additional rewards and incentives, as part of the Model test in 2024, up from 5.9 million in 2023 and 4.1 million in 2022. 

13 of the 69 MAOs participating in the VBID Model in 2024 are participating in the Hospice Benefit Component. These 13 organizations will test the inclusion of the Part A hospice benefit in MA benefits through 78 PBPs and in 19 states and Puerto Rico and 690 counties. In participating in this voluntary Model component, MAOs are incorporating the Medicare hospice benefit into MA covered benefits while offering comprehensive palliative care services outside the hospice benefit for enrollees with serious illnesses. In addition, participating MAOs are able to provide individualized, clinically appropriate transitional concurrent care through in-network providers and offer hospice-specific supplemental benefits.

All 69 participating MAOs prepared a health equity plan outlining how they will address potential inequities and disparities in access, outcomes, and/or enrollee experience of care across their participating Model components. Additionally, for MAOs participating in the Hospice Benefit Component, in CY 2024 CMS will continue to apply standardized access and equity-focused network adequacy requirements for MAO participants with at least one year of participation by the start of CY 2024. Data files further describing the quantitative element of these network adequacy requirements will be released on the VBID Model website in the coming months.

 MAO Participant Partners in the CY 2024 VBID Model

*Indicates participation in the Hospice Benefit Component of the VBID Model for CY 2024

For information on the 2024 VBID model, please click here.

For information on the Hospice Benefit Component, please click here, hospice benefit component, please click here.

Model Background

The VBID Model began in January 2017 and will be tested through December 2030. The Model is designed to test whether furnishing certain flexibilities in coverage and payment for MAOs, to promote MA health plan innovations would reduce Medicare program expenditures, enhance the quality of care MA enrollees receive, including dual-eligible enrollees, and improve the coordination and efficiency of health care service delivery.

Several changes have been made to the VBID Model since its initial implementation in 2017, all with the goal of testing additional flexibilities that we believe contribute to the modernization of the MA program. CMS is conducting this Model test through the CMS Innovation Center under section 1115A of the Social Security Act.

VBID originally tested allowing MAOs to structure enrollee cost-sharing and other plan design elements to encourage enrollees to use high-value clinical services, first for a limited set of conditions in a limited set of states, then removing that limitation on the original set of conditions and increasing the number of  states included in the Model in 2018 and 2019. In January 2019, for the 2020 plan year, CMS announced a broad array of changes, including allowing MA plans to provide reduced cost sharing and additional benefits to enrollees based on chronic condition, socioeconomic status, or both, even for non-primarily health related benefits, provide higher value Part C rewards and incentives, and provide Part D rewards and incentives, and requiring participating plans have a strategy to improve beneficiary wellness and health care planning. CMS was also required, through the Bipartisan Budget Act of 2018, to begin testing the Model in all 50 states and territories.

Additionally, in January 2019, CMS announced that beginning in CY 2021, through the Model, participating MAOs could apply to test the Medicare hospice benefit as a covered benefit under MA. CMS chose to announce this component of the VBID Model almost two years in advance of the initial performance year to allow all stakeholders, including MAOs, palliative and hospice care providers, beneficiary advocate groups, and others, to work together on how to ensure quality and safety for enrollees through the Model component. CMS is grateful for the broad engagement, support, and perspectives we have received from stakeholders and will continue to work with palliative and hospice care providers, MAOs, and all others in extending current relationships and building new ones in support of a successful implementation in CY 2024. 

In March 2020, CMS announced two new components of the VBID Model for CY 2021: (i) testing the impact of offering enrollees a mandatory supplemental benefit in the form of cash or monetary rebates available to all enrollees in a participating plan benefit package (PBP) (Cash or Monetary Rebates component); and (ii) removing any disincentives for MA plans to cover items and services that make use of new and existing technologies that are not covered by original Medicare. CMS has since discontinued the Cash or Monetary Rebates component of the VBID Model for CY 2023.

In March 2023, CMS announced that the MA VBID Model will be extended for calendar years 2025 through 2030 and will introduce changes intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness. CMS will share more information on model updates when available.

Beginning in CY 2024, all participants in the VBID Model are required to submit a VBID Health Equity Plan (HEP) that provides a detailed strategy for advancing health equity as part of their approach to participation in the Model. CMS collects information on and monitors the implementation of the VBID HEPs throughout the year.

The flexibilities continually added to the Model since its inception in 2017 have enabled a growing number of MAOs to participate in the Model test, which in turn means more enrollees are offered more diverse benefits as we test whether these flexibilities decrease costs or improve quality of care. CMS plans to publicly report more information on impacts and experiences with the Model in the coming months. Evaluation reports on the early years of the Model are available at: https://www.cms.gov/priorities/innovation/innovation-models/vbid.

CY 2025 VBID Request for Applications

Building on the continued growth and success of the VBID Model, CMS is planning to release its request for applications for CY 2025 in early winter 2024. CMS will release a separate CY 2025 request for applications for the Hospice Benefit Component as well, which is also planned for in early winter 2024.

The CY 2025 request for applications will introduce changes intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness. For more information and a preview of these changes, please visit https://www.cms.gov/priorities/innovation/vbid-extension-fs.  

Please reach out to the VBID Model at VBID@cms.hhs.gov with questions.

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