Medicare Advantage Plans Pulling Back On In-Home Care Supplemental Benefits

Medicare Advantage plans are scaling back their supplemental in-home care benefits, responding to increased congressional and regulatory scrutiny over their profits. This shift could result in reduced home-based care services through Expanded Primarily Health-Related Benefits (EPHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI) options. In 2024, the number of MA plans offering in-home support services (IHSS) as a supplemental benefit will decrease to 867, down from 1,308 plans in 2023. This reduction is attributed to administrative complexity, the challenge of identifying providers, building networks, and managing rising labor costs. Concurrently, changes in risk-adjustment processes affect MA plans' ability to purchase services for members. Insurers are now emphasizing benefits such as dental, vision, hearing, and transportation, reducing their focus on extensive in-home care offerings for 2024. Aetna, for instance, will offer an annual "healthy home visit" to members and access to primary care clinics, with a focus on prevention and wellness.