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.


Tthe 2019 U.S. Medi­care Hand­book has some new fea­tures: Se­niors in many states will be able to get ad­di­tional ser­vices like help with chores, safety de­vices and respite for care­givers.

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