The Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model is one way the Centers for Medicare and Medicaid Services (CMS) aims to address concerns related to rising healthcare costs and the quality of care. For the 2025 benefit year, CMS has expanded flexibility under VBID for Medicare Advantage organizations (MAOs), introducing new targeting criteria, as defined by the Area Deprivation Index (ADI). In this paper, we discuss: 

• The history of the VBID program
• The ADI landscape
• ADI as a new VBID targeting option
• Enrollee eligibility under ADI targeting
• MAO requirements for VBID participation
• Risks and opportunities for MAOs