Medi­care Ad­van­tage plans now cleared to go be­yond med­i­cal cov­er­age — even gro­ceries

Walker County Messenger - - Front Page - By Su­san Jaffe

Air con­di­tion­ers for peo­ple with asthma, healthy gro­ceries, rides to med­i­cal ap­point­ments and home-de­liv­ered meals may be among the new ben­e­fits added to Medi­care Ad­van­tage cov­er­age when new fed­eral rules take ef­fect next year.

On Mon­day, the Cen­ters for Medi­care & Med­i­caid Ser­vices (CMS) ex­panded how it de­fines the “pri­mar­ily health-re­lated” ben­e­fits that in­sur­ers are al­lowed to in­clude in their Medi­care Ad­van­tage poli­cies. And in­sur­ers would in­clude these ex­tras on top of pro­vid­ing the ben­e­fits tra­di­tional Medi­care of­fers.

“Medi­care Ad­van­tage ben­e­fi­cia­ries will have more sup­ple­men­tal ben­e­fits mak­ing it eas­ier for them to lead health­ier, more in­de­pen­dent lives,” said CMS Ad­min­is­tra­tor Seema Verma.

Of the 61 mil­lion peo­ple en­rolled in Medi­care last year, 20 mil­lion have opted for Medi­care Ad­van­tage, a pri­vately run al­ter­na­tive to the tra­di­tional gov­ern­ment pro­gram. Ad­van­tage plans limit mem­bers to a net­work of providers. Sim­i­lar re­stric­tions may ap­ply to the new ben­e­fits.

Many Medi­care Ad­van­tage plans al­ready of­fer some health ben­e­fits not cov­ered by tra­di­tional Medi­care, such as eyeglasses, hear­ing aids, den­tal care and gym mem­ber­ships. But the new rules, which the in­dus­try sought, will ex­pand that sig­nif­i­cantly to items and ser­vices that may not be di­rectly con­sid­ered med­i­cal treat­ment.

CMS said the in­sur­ers will be per­mit­ted to pro­vide care and de­vices that pre­vent or treat ill­ness or in­juries, com­pen­sate for phys­i­cal im­pair­ments, ad­dress the psy­cho­log­i­cal ef­fects of ill­ness or in­juries, or re­duce emer­gency med­i­cal care.

Al­though in­sur­ers are still in the early stages of de­sign­ing their 2019 poli­cies, some com­pa­nies have ideas about what they might in­clude. In ad­di­tion to trans­porta­tion to doc­tors’ of­fices or bet­ter food op­tions, some health in­surance ex­perts said ad­di­tional ben­e­fits could in­clude sim­ple mod­i­fi­ca­tions in ben­e­fi­cia­ries’ homes, such as in­stalling grab bars in the bath­room, or aides to help with daily ac­tiv­i­ties, in­clud­ing dress­ing, eat­ing and other per­sonal care needs.

“This will al­low us to build off the ex­ist­ing ben­e­fits that we al­ready have in place that are fo­cused more on pre­ven­tion of avoid­able in­juries or ex­ac­er­ba­tion of ex­ist­ing health con­di­tions,” said Alicia Kel­ley, di­rec­tor of Medi­care sales for Cap­i­tal Dis­trict Physi­cians’ Health Plan, a non­profit serv­ing 43,000 mem­bers in 24 up­state New York coun­ties.

Even though a physi­cian’s or­der or pre­scrip­tion is not nec­es­sary, the new ben­e­fits must be “med­i­cally ap­pro­pri­ate” and rec­om­mended by a li­censed health care provider, ac­cord­ing to the new rules.

Many ben­e­fi­cia­ries have been at­tracted to Medi­care Ad­van­tage be­cause of its ex­tra ben­e­fits and the limit on out-of-pocket ex­penses. How­ever, CMS also cau­tioned that new sup­ple­men­tal ben­e­fits should not be items pro­vided as an in­duce­ment to en­roll.

The new rules “set the stage to con­tinue to in­no­vate and pro­vide choice,” said Cathryn Don­ald­son, of Amer­ica’s Health In­surance Plans, a trade group.

“CMS is catch­ing up with the rest of the world in terms of its un­der­stand­ing of how we keep peo­ple healthy and well and liv­ing longer and in­de­pen­dently, and those are all pos­i­tive steps,” said Ceci Con­nolly, chief ex­ec­u­tive of­fi­cer of the Al­liance of Com­mu­nity Health Plans, which rep­re­sents non­profit health in­surance plans. Some of­fer non­emer­gency med­i­cal trans­porta­tion, low-cost hear­ing aids, a mo­bile den­tal clinic and a “gro­cery on wheels,” to make shop­ping more con­ve­nient, she said.

Unit­edHealth­care, the largest health in­surer in the U.S., also wel­comes the op­por­tu­nity to ex­pand ben­e­fits, said Matt Burns, a com­pany spokesman. “Medi­care ben­e­fits should not be one-size-fits-all, and con­tin­ued rate sta­bil­ity and greater ben­e­fit de­sign flex­i­bil­ity en­able health plans to pro­vide a more per­son­al­ized health care ex­pe­ri­ence,” he said.

But pa­tient ad­vo­cates in­clud­ing David Lip­schutz. se­nior pol­icy at­tor­ney at the Cen­ter for Medi­care Ad­vo­cacy, are con­cerned about those who may be left be­hind. “It’s great for the peo­ple in Medi­care Ad­van­tage plans, but what about the ma­jor­ity of the peo­ple who are in tra­di­tional Medi­care?” he asked. “As we tip the scales more in fa­vor of Medi­care Ad­van­tage, it’s to the detri­ment of peo­ple in tra­di­tional Medi­care.”

The de­tails of the 2019 Medi­care Ad­van­tage ben­e­fit pack­ages must first be ap­proved by CMS and will be re­leased in the fall, when the an­nual open en­roll­ment be­gins. It’s very likely that all new ben­e­fits will not be avail­able to all ben­e­fi­cia­ries since there is “tremen­dous vari­a­tion across the coun­try” in what plans of­fer, said Gretchen Jacobson, as­so­ciate di­rec­tor of the Kaiser Fam­ily Foun­da­tion’s Pro­gram on Medi­care Pol­icy. (Kaiser Health News is an ed­i­to­ri­ally in­de­pen­dent pro­gram of the foun­da­tion.)

Ad­dress­ing a pa­tient’s health and so­cial needs out­side the doctor’s exam room isn’t a new con­cept. The In­sti­tute on Ag­ing, for ex­am­ple, is a Cal­i­for­nia non­profit that of­fers health, so­cial, and psy­cho­log­i­cal ser­vices for se­niors and adults with dis­abil­i­ties. It has helped peo­ple in San Fran­cisco and South­ern Cal­i­for­nia move from nurs­ing homes to their own homes and pro­vides a va­ri­ety of ser­vices to make their new lives eas­ier, from kitchen sup­plies to wheel­chair ramps.

“By tak­ing a more in­te­grated ap­proach to ad­dress peo­ple’s so­cial and health needs, we have seen up to a 30 per­cent sav­ings in health care costs com­pared to the costs of the same in­di­vid­u­als be­fore they joined our pro­gram,” said Dustin Harper, the in­sti­tute’s vice pres­i­dent for strate­gic part­ner­ships. The agency serves 20,000 Cal­i­for­ni­ans a year, in­clud­ing for­mer nurs­ing home res­i­dents, who qual­ify for Medi­care or Med­i­caid, the fed­er­al­state health in­surance pro­gram for low-in­come peo­ple, or both.

In ad­di­tion to next year’s changes in sup­ple­men­tal ben­e­fits, CMS also noted that a new fed­eral law al­lows Medi­care Ad­van­tage plans to of­fer ben­e­fits that are not pri­mar­ily health-re­lated for Medi­care Ad­van­tage mem­bers with chronic ill­nesses. The law and the agency’s changes are com­ple­men­tary, CMS of­fi­cials said. They promised ad­di­tional guid­ance in the com­ing months to help plans dif­fer­en­ti­ate be­tween the two.

KHN’s cov­er­age re­lated to ag­ing and im­prov­ing care of older adults is sup­ported in part by The John A. Hart­ford Foun­da­tion.

This is one of sev­eral vans that pro­vides door-to-door ser­vice for se­niors and adults with dis­abil­i­ties go­ing to med­i­cal ap­point­ments and pro­grams at the In­sti­tute on Ag­ing in San Fran­cisco. (Photo/ Su­san Jaffe)

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