More Medicare
Presbyterian boosts coverage for seniors
Presbyterian boosts coverage 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.
That may also help elderly people stay in their homes longer.
At least one New Mexico insurer is offering some of the additional services in its Advantage plans.
Presbyterian Health Plan has added chiropractic care and hearing aid purchases, all of which will be available with a co-pay through the company’s Advantage plans, said Dr. Jason Mitchell, chief medical officer of Presbyterian Healthcare Services. Also, it lowered the co-pays for physical therapy and behavioral health, he said.
Presbyterian is not offering respite for caregivers, but it does already cover some in-home services.
All of the changes, made in consultation with primary care doctors, are meant to lower health care costs and provide better service for patients, Mitchell said.
Howard Gleckman, a senior researcher at the nonpartisan Urban Institute think tank, said the newly covered services are similar to what people might need if they required long-term care.
“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, still the
choice of two out of three 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.
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.