Medicare to offer some in-home support
Medicare is experimenting with a new direction in healthcare. Starting this year, Medicare beneficiaries in many states will be able to get additional services — such as help with chores and respite for caregivers — through private Medicare Advantage insurance plans.
There’s a growing recognition that such practical help 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. That may also help people stay in their homes longer.
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 in Washington, D.C.
“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,” Gleckman said.
Change is starting slowly. Policymakers have yet to figure out how to bring similar benefits to traditional Medicare, which remains the choice of 2 out of 3 beneficiaries.
Available in Virginia
The new services are being offered by some Medicare Advantage plans in more than 20 states this year, including Virginia, but not yet Maryland or the District of Columbia. More states are expected to be added over time.
There has to be a health-related reason to qualify, and costs will vary. 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.
Nearly 23 million Medicare beneficiaries, or more than 1 in 3, 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 some other restrictions — such as the need for prior authorization for services. It’s a growing business for insurers.
Medicare Advantage open enrollment for 2019 ended in early December, but Medicare recipients should keep this in mind for the next enrollment period, which will start in October.
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.
The new benefits take that to a higher level, with Medicare’s blessing.
“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.”
Acupuncture to home care
Insurers under Anthem’s corporate umbrella offer different packages in 12 of 21 states where they operate Medicare plans. They can include adult day care center visits, a personal helper at home, or alternative medicine, like acupuncture.
Other major insurers like UnitedHealthcare and Humana are also participating. It’s a calculated gamble for insurers, who still have to make a profit.
And the limited new benefits are 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 first.
“Medicare policy has not kept up with the times,” said Sen. Ron Wyden, D-Ore., one of the authors of bipartisan legislation seen as a catalyst for expanded services through Medicare Advantage.
Wyden said he’s working to bring similar options to traditional Medicare. “Clearly this is going to have to be an effort that is going to have to be built out,” he added.
The changes represent a rare consensus at a time when healthcare is among the most politically divisive of issues. 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 Trump administration issued regulations in the spring trying to accelerate the changes.
According to Medicare, 12 insurers will be offering expanded supplemental benefits this 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.
Medicare estimates that some 780,000 beneficiaries will have access to the new benefits. In-home helpers and support for caregivers are the most popular.
Consumer advocates recommend that seniors carefully weigh whether Medicare Advantage is best for them. If they don’t like it, they can go back to traditional Medicare, but those with a pre-existing condition may not be able to buy a Medigap policy to help cover out-of-pocket costs. They can also switch to another Medicare Advantage plan.
Medicare doesn’t pay the insurers more for offering added benefits. Under a complex formula, they’re primarily financed out of the difference between bids submitted by insurers and Medicare’s maximum payment to plans. If the companies bid below Medicare’s rate, they can return some of that to beneficiaries in the form of added benefits.