Medicare Advantage Value-Based Insurance Design Model Calendar Year 2021 Model Participation

The Centers for Medicare & Medicaid Services (CMS) is releasing the Calendar Year (CY) 2021 participation in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model and information about the CY 2022 application process for eligible MA organizations.

Model Background

The VBID Model began in January 2017 and will be tested through December 2024. The Model is designed to test whether furnishing certain flexibilities in coverage and payment for MA organizations, to promote MA health plan innovations, would reduce Medicare program expenditures, enhance the quality of care Medicare beneficiaries receive, including dual-eligible beneficiaries, 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 MA organizations 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 included states 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, 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 MA organizations could apply to test the Medicare hospice benefit as a covered benefit.  CMS chose to announce this component of the VBID Model almost two years in advance of the start of performance beginning to allow all stakeholders, including CMS, MA organizations, palliative and hospice care providers, beneficiary advocate groups, and others, to work together on how to ensure quality and safety for beneficiaries 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, MA organizations, and all others in extending current relationships and building new ones in support of a successful CY 2021 implementation. 

In March 2020, executing on President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors, CMS announced two new components of the VBID Model for CY 2021: (i) testing the impact of offering beneficiaries a mandatory supplemental benefit in the form of cash or monetary rebates, available to all enrollees in an participating plan benefit package (PBP); 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. 

CY 2021 VBID Model Participation                                                                                                             

For CY 2021, VBID Model participation continued to build on the substantial growth seen in CY 2020. For CY 2021, the VBID Model has 19 participating MA organizations, up from 10 in 2019 and 14 in 2020. These 19 participating MA organizations are testing the Model in 45 states, DC, and Puerto Rico through 451 PBPs, up from 7 states in 2019 and 30 states and Puerto Rico in 2020, and 56 and 157 participating PBPs, respectively, each year. A total of 4.6 million beneficiaries are projected to be enrolled in participating PBPs, an increase from approximately 440,000 beneficiaries in 2019 and 1.2 million in 2020, with over 1.6 million beneficiaries expected to be targeted to receive additional supplemental benefits through the Model, up from 82,000 in 2019 and 280,000 in 2020. For more information on the service areas, please visit the VBID Model website.

The following MA organizations are participating in the CY 2021 VBID Model:

* Indicates participation in the Hospice Benefit Component of the Model for CY 2021

Under the Model, in CY 2021, nine MA organizations, through 53 PBPs, will participate in the Hospice Benefit Component of the VBID Model. These PBPs will test the Hospice Benefit Component in service areas that cover 206 counties. For more information on the service areas, please visit the VBID Model website.

CY 2022 VBID Request for Applications

Building on the continued growth and success of the VBID Model, CMS will release a request for applications for CY 2022 in Fall 2020. CMS will release a separate CY 2022 request for applications for the Hospice Benefit Component as well in Fall 2020.

For more information please visit https://innovation.cms.gov/initiatives/vbid.

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