Medicare Advantage will offer seniors help at home
New services available in plans in 20 states next year.
WASHINGTON — In a harbinger of potentially big changes for Medicare, seniors in many states will be able to get additional services such as help with chores, safety devices and respite for caregivers next year through private Medicare Advantage insur- ance plans.
The shift reflects a growing recognition that simple help at home can have a mean- ingful 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 ser- vices 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. “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.”
Change is starting slowly. The services will be offered by some Medicare Advantage plans in about 20 states, including Ohio, next year, a number expected to grow.
There has to be a health-re- lated 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 hos- pitals andother 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 ben- eficiaries and their families will have to rely on promotional materials from insurers.
For years, Medicare has permitted private plans to offer supplemental bene- fits not covered by the traditional program. Think free gym memberships, transpor- tation to medical appoint- ments or home-delivered meals after 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.”
Insurers under Anthem’s corporate umbrella are offer- ing different packages in 12 of 21 states they operate in. They can include alternative medicine, like acupuncture, or adult day care center visits or a personal helper at home.
Other major insurers like United Healthcare and Humana are participating.
Still, Medicare’s opening is 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 lifesavings.
“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, which is still the choice of 2 out of 3 seniors. “Clearly this is going to have to be an effort that is going to have to be built out,” he added.
According to Medicare, 12 insurers will be offering expanded supplemental benefits next 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.