Medicare Advantage VBID Termination: What Agents Need to Know
The Centers for Medicare & Medicaid Services (CMS) announced the Medicare Advantage VBID termination. The Value-Based Insurance Design (VBID) Model will officially end after the 2025 plan year. This marks the end of a decade-long initiative aimed to innovate care delivery and cost management in Medicare Advantage. For agents, brokers, and plan sponsors, it’s important to understand what this change means and how to prepare.
A Quick Recap: What Was the VBID Model
Launched in 2017, the VBID Model was designed to test new approaches to delivering Medicare Advantage benefits. Its goal was to improve health outcomes and reduce costs. This allowed plans to tailor benefits based on chronic conditions, offer enhanced supplemental benefits, and experiment with cost-sharing structures that promoted high-value care.
Over time, the model evolved to include features like:
- Chronic Condition Special Needs Plan (C-SNP) enhancements
- Reduced or waived cost-sharing for high-value services
- Incentive programs for beneficiaries
- Expanded telehealth access
- Integration of Medicare hospice benefits (starting in 2021 as part of a separate Hospice Benefit Component pilot)
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Why Is CMS Ending the Model
Although VBID showed promise in some areas, CMS reported mixed results in measurable improvement in cost savings and health outcomes. Despite some plans reported success, the model overall did not produce consistent, scalable results that justified its continuation beyond 2025.
The separate Hospice Benefit Component, a key aspect of the VBID experiment since 2021, will also end in 2025. CMS plans to use the lessons learned from this model to inform future policy and innovation strategies.
What This Means for Agents and Beneficiaries
If you’ve worked with clients enrolled in VBID-participating Medicare Advantage plans, now is the time to start tracking changes for 2026. Although the VBID Model is ending, plans may still continue some of the supplemental and chronic condition benefits on their own; just outside of the CMS demonstration model.
Here’s what to keep in mind:
- No disruption for 2025: Plans participating in VBID will continue as usual for the rest of the plan year.
- Prepare for benefit shifts in 2026: Expect changes in cost-sharing structures, supplemental benefits, and chronic condition management tools once the model concludes.
- Watch for new CMS innovations: While VBID is ending, CMS may introduce new pilots or value-based initiatives influenced by VBID findings.
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The sunsetting of the VBID Model is a significant development for the Medicare Advantage landscape. As an agent, staying proactive by reviewing carrier updates, analyzing plan adjustments, and educating clients about any changes will be critical. Although one model is ending, the pursuit of value-based care in Medicare is far from over.
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Stay tuned for more CMS announcements and be ready to pivot as the industry evolves.
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