ome seniors with Medicare Advantage plans will be able to get coverage for home care services which can help delay or avoid costly hospital visits and long-term care. According to a report by cbsnews.com, the benefits will be available in 2019 for 20 states and is expected to grow from there. The changes and new direction also represent a rare consensus between the political parties on healthcare planning (emphasis added).
Seniors in many states will be able to receive additional services such as help with chores, safety devices and respite for caregivers next year through private “Medicare Advantage” insurance plans.
It’s a harbinger of potentially big changes for Medicare, reflecting a growing recognition that simple help at home can have a meaningful impact on patients’ well-being — and reduce some costs for taxpayers. A couple of hundred dollars to install grab bars in the shower can prevent a fall leading to a broken hip, a life-changing injury.
The newly covered services are similar to what people might need if they required long-term care, said Howard Gleckman, a senior researcher at the nonpartisan Urban Institute think tank. “It begins to break down the wall between long-term care and Medicare, which with very few exceptions, has never paid for long-term care.”
Change is starting slowly, which may make it tough for seniors to find plans that offer the services. The services will be offered by some Medicare Advantage plans in about 20 states next year, expected to grow over time.
About 780,000 beneficiaries will have access to the new benefits next year, or a fraction of the 23 million Medicare beneficiaries with Advantage plans. In-home helpers and support for caregivers are the most popular.
There has to be a health-related reason to qualify, and costs will vary among plans. In some plans, there’s no added cost. But limits do apply. For example, a plan may cover one day per week at an adult day care center.
More than 1 in 3 Medicare recipients are expected to be covered by a Medicare Advantage plan next year. The private plans generally offer lower out-of-pocket costs in exchange for limits on choice of doctors and hospitals and other restrictions such as prior authorization for services. It’s a growing business for insurers.
Medicare Advantage open enrollment for 2019 ends Dec. 7, providing seniors with a chance to make changes to their health care coverage. For instance, experts recommend that seniors make sure they are covering their coverage gaps with supplement plans or an Advantage plan.
But it’s not easy to use Medicare’s online plan finder to search for plans with expanded benefits, so beneficiaries and their families will have to rely on promotional materials that insurers mail during open enrollment.
For years, Medicare has permitted private plans to offer supplemental benefits not covered by the traditional program. Think free gym memberships, transportation to medical appointments or home-delivered meals following a hospitalization.
“It is a big concept, in the sense that it is officially encouraging plans to get across the line into the many, many things that affect the health and well-being of beneficiaries,” said Marc Russo, president of insurer Anthem’s Medicare business. “I, for one, who have been in and around Medicare for decades, believe it pays.”
Insurers under Anthem’s corporate umbrella are offering different packages in 12 of 21 states they operate in. They can include alternative medicine, like acupuncture, or adult day care center visits or a personal helper at home.
Other major insurers like UnitedHealthcare and Humana are participating.
Still, Medicare’s opening is no substitute for full long-term care coverage, which many people need for at least part of their lives and remains prohibitively expensive. Seniors trying to get long-term care through Medicaid — the program for low-income people — must spend down their life savings.
The article goes on to describe the rare unity between the two major political parties…
The changes represent a rare consensus at a time when health care issues are among the most politically divisive. Republican and Democratic lawmakers, as well as Seema Verma, the Trump administration’s Medicare chief, are pulling in the same direction.
The idea of broader services through Medicare Advantage was embodied in a bipartisan Senate Finance Committee bill to improve care for chronically ill seniors. The legislation got spliced into a massive budget bill passed earlier this year. The Trump administration issued regulations in the spring trying to accelerate the changes.
According to Medicare, 12 insurers will be offering expanded supplemental benefits next year through 160 plans in 20 states. In four other states and Puerto Rico, such benefits may be available to seniors with certain health conditions…
Thumbnail courtesy of cbsnews.com
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