The Centers for Medicare & Medicaid Services (CMS) is announcing the Calendar Year (CY) 2025 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model.
As part of the VBID Model, MA plans offer additional supplemental benefits and/or reduced cost sharing (in some cases to zero). MA plans participating in the VBID Model may also use reward and incentive programs.
CY 2025 VBID Model Participation
For CY 2025, the VBID Model has 62 participating Medicare Advantage Organizations (MAOs) testing the model in 48 states, D.C., and Puerto Rico through 967 plan benefit packages (PBPs).
All 62 participating MAOs prepared Health Equity Plans on how they will address potential inequities and disparities in access, outcomes, and/or enrollee experience of care as it relates to their participation in the VBID Model. Additionally, for CY 2025, the model introduces additional reporting and requirements for MAOs, such as a requirement to offer benefits that address enrollees’ health-related social needs (HRSNs), as well as the ability for participating MAOs to target supplemental benefits to enrollees living in the most underserved area deprivation index (ADI) areas.
The following MAOs are participant partners in the VBID Model for CY 2025:
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For information on the VBID Model for CY 2025, please click here.
Model Background
The VBID Model began in January 2017 and 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 Medicare 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 may contribute to the modernization of the MA program. CMS is conducting this model test through the Innovation Center under section 1115A of the Social Security Act.
The VBID Model initially 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 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, provide higher value Part C rewards and incentives, and provide Part D rewards and incentives. CMS also required that participating plans have a strategy to improve individual wellness and health care planning. CMS was also required, through the Bipartisan Budget Act of 2018, to begin testing the VBID Model in all 50 states and territories. CMS has discontinued the Part C Rewards and Incentives component of the VBID Model for CY 2025.
Additionally, in January 2019, CMS announced that beginning in CY 2021, through the VBID Model, participating MAOs could apply to test the Medicare hospice benefit as a covered benefit. The Hospice Benefit Component is set to run through the end of 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 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 Traditional Medicare. CMS discontinued the Cash or Monetary Rebates component of the VBID Model in CY 2023 and the new and existing technologies flexibility for CY 2025.
Beginning in CY 2023, participants in the VBID Model also have the option of participating in a voluntary Health Equity Incubation Program. The goal of the Health Equity Incubation Program is to help drive a critical mass of interventions in the most promising focus areas (e.g., around addressing food and nutritional insecurity), optimize design and implementation of best practices for interventions focused on health equity, and build and share an evidence base for quality improvement and medical savings related to interventions that address HRSNs.
For CY 2025, participants in the VBID Model will be required to offer a minimum of two supplemental benefits to address priority HRSNs from among the categories of food and nutrition, transportation, and housing and living environment. Participants will also be permitted to target supplemental benefits to enrollees living in the most underserved ADI areas to address HRSNs through evidence-based benefits tailored to community-identified needs.
For CY 2025, the CMS Innovation Center also revised certain aspects of the VBID Model’s design in response to evaluation findings to ensure the model has the right tools in place to meet statutory requirements. The changes to the VBID Model since its inception in CY 2017 have enabled CMS to test whether these flexibilities decrease costs and/or improve quality of care. CMS will continue to publicly report on impacts and experiences with the model.
For more information on the VBID Model, please visit https://innovation.cms.gov/initiatives/vbid.
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