Medicare expands access to in-home support for seniors

WASHINGTON—Medicare is experimenting with a new direction in health care. Starting next year, seniors 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.

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.

Change is starting slowly. Policymakers have yet to figure out how to bring similar benefits to traditional Medicare, still the choice of 2 out of 3 seniors.

The new services will be offered by some Medicare Advantage plans in more than 20 states next year, and that’s expected to grow over time.

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.

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 other restrictions such as prior authorization for services. It’s a growing business for insurers.

Medicare Advantage open enrollment for 2019 ends Dec. 7. 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 where they operate Medicare plans. 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. It’s a calculated gamble for insurers, who still have to make a profit.