Heads Up: Medicare Advantage Value-Based Insurance Design (VBID) Model ending in 2025

[GailL1]

 This is just a reminder for anybody that currently has a Medicare Advantage Value-Based Insurance Design (VBID) Model this year.  They are ending this program in 2025.  

Some of the design features may not be lost since enrollees who choose to remain in MA will likely be able to access many of the same benefits after VBID’s termination (e.g., transportation to medical appointments, healthy food assistance), because many elements of the VBID model have become benefits that can be offered in the MA program.

The SSBCI  ( Special Supplemental Benefits for the Chronically Ill ) is continuing and also allows MA plans to offer similar interventions to those available under the VBID model. MA plans will be able to leverage similar pathways and help enrollees maintain access to supplemental benefits that meet their needs.  For a SSBCI plan, from what I understand, there will be a specification that the specific chronic illness - one or more -  be define by health records. 

[CBtoo]

As a general reminder... if you are in any medicare advantage plan (less likely to happen to a company's supplement plans but can) that is terminated, that gives you guaranteed acceptance (called guaranteed issue) into supplements WITHOUT having to pass medical underwriting (provided you act promptly). 

[GailL1]

@CBtoo 

These are a SPECIFIC type of Medicare Advantage plans for certain people with chronic disease. 

CMS.gov - Medicare Advantage Value-Based Insurance Design Model 

Background on Medicare Advantage (MA)

MA plans offer Medicare beneficiaries an alternative to Traditional Medicare. In addition to covering all Medicare services, some MA plans also offer enrollees extra coverage through supplemental benefits such as vision, hearing, and dental services. Some MA plans may offer prescription drug coverage (Part D) as part of their plan.

MA plans can charge different out-of-pocket costs for certain services within guidelines defined by Medicare. Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure cost-sharing and other health plan design elements to encourage enrollees to use the services that can benefit them the most.

Currently, Medicare beneficiaries may enroll into MA and have access to all Traditional  Medicare benefits plus additional supplemental benefits beyond what original Medicare covers. Historically, when an MA enrollee elects hospice, Traditional Medicare becomes responsible for most services while the MA organization retains responsibility for certain services (e.g., supplemental benefits). This hospice “carve-out” from MA results in a convoluted set of coverage rules for MA enrollees who elect hospice and fragments accountability for care and financial responsibility across the care continuum that the Hospice Benefit Component of the VBID Model seeks to address.

.. . . For Calendar Year (CY) 2025, the VBID Model has 62 participating Medicare Advantage Organizations (MAOs) projecting to offer over seven million enrollees additional Model benefits and/or rewards and incentives as part of the Model test in 2025.

more at the link ~

The model was being tested by CMS -  like I said in my info post - some (or all)  of  the benefits that were included in the VBID will be available in other special plans for those who qualify based on their chronic disease category.

CMS was the government agency that began the defined plan design, the yearly testing of the affects and now, the termination of such as was planned - this was just a reminder for those who have such a plan (or their representative) to take action for 2026.  

[CBtoo]

That is good additional information for people but has nothing to do with my post.

My post was only a reminder that if their plan is cancelled/terminated then they can choose whatever plan they want that they qualify for, including a supplement, without having to go through medical underwriting (of course to switch advantage plans they don't need to go through medical underwriting anyway).

There are LOTS of plans being terminated across the board for 2026. Some people are being auto enrolled in another one BUT they can choose for that not to happen and choose something else.

[GailL1]

@CBtoo 

It is the SUBJECT of THIS thread - note the heading

”Heads Up: Medicare Advantage Value-Based Insurance Design (VBID) Model ending in 2025”

Yes, there are a lot of MAPD plans being cancelled - there are even insurers that are leaving the Medicare marketplace all together.  

This (subject) is a specific needs plans and thus people on this type of plan probably cannot afford a Medigap but your are right - a MAPD insurer that goes out of business in a specific area does trigger a SEP for most Medigap plans (not Plan N or M) - 

[Winter2025VA]

[9/16/25] Carolyn @CBtoo , thank you for your VERY HELPFUL post dear friend. You ALWAYS post info I can use. Take care, Nicole!

➡️[*** CAROLYN 

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@CBtoo wrote:

That is good information for people but has nothing to do with my post. My post was only a reminder that if their plan is cancelled then they can choose whatever they want without having to go through medical underwriting. 

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