Customized Care for Complex Conditions in Medicare Advantage

Medicare beneficiaries frequently select suboptimal Medicare Advantage plan products or elect traditional fee-for-service Medicare due to choice paralysis, cognitive impairments, and consumer health insurance illiteracy. Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs) offer an opportunity to tie disease to both plan design and marketing, simplifying consumer choice architecture. This report explores additional refinement in the C-SNP program to help unlock this potential, examining programmatic regulatory requirements, qualifying diseases, and marketing rules with an aim to improving care for multi-morbid Medicare beneficiaries.
Now comprising nearly 20 percent of national health care spending, or $829.5 billion annually, the Medicare program continues to evolve (CMS 2021d). Originally designed to finance acute care characterized by [...]