Medi­care ex­pands ac­cess to in-home sup­port

The Beaufort Gazette - - News - BY RI­CARDO ALONSO-ZALDIVAR

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 lifechang­ing in­jury.

That may also help el­derly peo­ple stay in their homes longer.

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.

“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 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.

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