As an FMO, our goal is to keep agents prepared and informed about shifts in the Medicare landscape. One of the biggest changes on the horizon is the end of the Value-Based Insurance Design (VBID) model. With VBID set to expire on December 31, 2025, now is the time to understand what’s changing, how it may impact Medicare Advantage (MA) plans, and what this means for the beneficiaries you serve.
What Is VBID?
The Value-Based Insurance Design (VBID) model, created by the CMS Innovation Center, allowed Medicare Advantage plans to offer targeted cost-sharing reductions and supplemental benefits to specific populations. These often included:
- People with chronic conditions
- Low-income individuals
- Members in underserved areas
Through VBID, many plans offered extra support such as $0 drug copays, meal delivery, transportation assistance, and even rewards for healthy behaviors.
Why Is VBID Ending?
CMS announced that VBID will end after 2025 because evaluations showed it created “substantial and unmitigable costs” for the Medicare Trust Funds. While the program generated innovation and tested new approaches, CMS determined it was not financially sustainable in the long term.
Plans have had over a year’s notice to prepare for the transition to 2026, but agents should expect real changes in how benefits look moving forward.
How the End of VBID May Impact MA & PPO Plans
Although VBID wasn’t limited to PPOs, many MA plans (including PPOs) relied on its flexibilities. When VBID sunsets, the following areas are most at risk:
1. Cost-Sharing Reductions
- With VBID: Some members received reduced or $0 copays for certain drugs or services.
- After VBID: These reductions may no longer apply unless plans find alternative benefit authorities.
2. Social Determinant Benefits
- With VBID: Plans could use rebates to cover things like food, transportation, or housing supports.
- After VBID: Some benefits may survive under the Special Supplemental Benefits for the Chronically Ill (SSBCI), but not all will transfer.
3. Targeting Flexibility
- With VBID: Carriers had more freedom to tailor benefits to specific groups.
- After VBID: Targeting will be limited to what is allowed under standard MA and SSBCI rules.
4. Rewards & Incentives
- With VBID: Plans could reward members for medication adherence or healthy behaviors.
- After VBID: These programs may be scaled back or eliminated.
5. Dual-Eligible Populations
- With VBID: D-SNP members often benefited most from enhanced VBID supports.
- After VBID: These beneficiaries may experience the most disruption, with fewer $0 cost-sharing options and reduced nonmedical supports.
The bottom line is that many of the extras agents and clients have come to expect may not continue after 2025.
Plans have had over a year’s notice to prepare for the transition to 2026, but agents should expect real changes in how benefits look moving forward.
The Silver Lining: SSBCI Remains
Not all is lost. While VBID ends, the Special Supplemental Benefits for the Chronically Ill (SSBCI) program continues.
What Is SSBCI?
Created under the CHRONIC Care Act of 2018, SSBCI allows MA plans to offer non-medical benefits to chronically ill members if they help maintain or improve health. These can include:
- Food cards or meal delivery
- Transportation to non-medical locations (like the grocery store)
- Pest control or air purifiers
- Home modifications (grab bars, ramps, etc.)
- Social support services
Why It Matters
Many benefits offered under VBID can transition into SSBCI. Carriers can still provide valuable non-medical supports — but eligibility is restricted to those with qualifying chronic conditions.
What Agents Should Do
To stay ahead of these changes and serve clients effectively, agents should:
- Review Carrier Benefits for 2026
Compare supplemental benefits and cost-sharing details carefully when new materials are released.
Ask Carriers Directly
Find out which benefits were tied to VBID and whether they will continue under SSBCI or other authorities.
Communicate Clearly With Clients
Set expectations: benefits available in 2025 may not look the same in 2026.
Highlight SSBCI Options
Explain how many benefits can still be offered — just through a different pathway.
Stay Informed on CMS Updates
Future policy may incorporate lessons from VBID into broader MA benefit rules.
How to Talk to Clients
When explaining this change to beneficiaries, keep it simple and reassuring:
- “Some of the extra benefits you enjoy today may look different in 2026 because a federal model called VBID is ending.”
- “Don’t assume your favorite benefit will stay in place — let’s review your options carefully once new plans are released.”
- “The good news is many of these benefits may still be available under other rules like SSBCI, but eligibility could change.”
Final Takeaway
VBID’s sunset is a major shift, but it’s not the end of enhanced MA benefits. Many supports can still be offered through SSBCI and other pathways. For agents, the key is preparation: stay educated, ask the right questions, and guide clients through plan reviews with care.
Your role is more important than ever in helping seniors understand the changing landscape and ensuring they have the coverage and support they need.
