Medicare Advantage Plan Spending and Payments Under the Hospice Carve-Out.

ABSTRACT:

Importance

In 2021, the Centers for Medicare & Medicaid Services implemented a Value-Based Insurance Design (VBID) model to test the impact of including hospice services in the Medicare Advantage (MA) benefits package. In December 2024, the VBID was ended following widespread dissatisfaction, signaling a return to the hospice carve-out model. Under the carve-out model, after an MA enrollee elects hospice, health care related to their terminal illness is paid for by fee-for-service (FFS) Medicare. MA plans stop receiving the inpatient and outpatient portions of that enrollee's capitated payment but continue to receive premium and rebate payments.

Objective

To estimate MA plan spending relative to premium and rebate payments for hospice enrollees under the carve-out model.

SUBMITTER: Bellerose M 

PROVIDER: S-EPMC12365699 | biostudies-literature | 2025 Aug

REPOSITORIES: biostudies-literature