Added ben­e­fits

Medi­care boosts in-home ser­vices

The Maui News - - FRONT PAGE - By RI­CARDO ALONSO-ZALDIVAR

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.

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-of­pocket 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.

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.

“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 well­be­ing 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 of­fer­ing dif­fer­ent pack­ages in 12 of 21 states where they op­er­ate Medi­care plans. They can in­clude al­ter­na­tive medicine, like acupunc­ture, or adult day care cen­ter vis­its or a per­sonal helper at home.

Other ma­jor in­sur­ers like Unit­edHealth­care and Hu­mana are par­tic­i­pat­ing. It’s a cal­cu­lated gam­ble for in­sur­ers, who still have to make a profit.

And the lim­ited new ben­e­fits are no sub­sti­tute for full longterm 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 life sav­ings.

“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.

“Clearly this is go­ing to have to be an ef­fort that is go­ing to have to be built out,” he added.

The changes rep­re­sent a rare con­sen­sus at a time when health care is­sues are among the most po­lit­i­cally di­vi­sive. Repub­li­can and Demo­cratic law­mak­ers, as well as Seema Verma, the Trump ad­min­is­tra­tion’s Medi­care chief, are pulling in the same di­rec­tion.

The idea of broader ser­vices through Medi­care Ad­van­tage was em­bod­ied in a bi­par­ti­san Se­nate Fi­nance Com­mit­tee bill to im­prove care for chron­i­cally ill se­niors. The Trump ad­min­is­tra­tion is­sued reg­u­la­tions in the spring try­ing to ac­cel­er­ate the changes.

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.

“The guid­ance came out fairly late in the an­nual plan­ning process, and that’s one rea­son why some of these ben­e­fits may start out small,” said Steve Warner, head of Medi­care Ad­van­tage pro­gram de­vel­op­ment for Unit­edHealth­care.

Medi­care es­ti­mates that some 780,000 ben­e­fi­cia­ries will have ac­cess to the new ben­e­fits next year. In-home helpers and sup­port for care­givers are the most pop­u­lar.

Con­sumer ad­vo­cates rec­om­mend that se­niors care­fully weigh whether Medi­care Ad­van­tage is best for them. If they don’t like it, they can go back to tra­di­tional Medi­care, but those with a pre-ex­ist­ing con­di­tion may not be able to buy a Medi­gap pol­icy to help cover out-of­pocket costs. They can also switch to an­other Medi­care Ad­van­tage plan.

Medi­care doesn’t pay the in­sur­ers more for of­fer­ing added ben­e­fits. Un­der a com­plex for­mula, they’re pri­mar­ily fi­nanced out of the dif­fer­ence be­tween bids sub­mit­ted by in­sur­ers and Medi­care’s max­i­mum pay­ment to plans. If the com­pa­nies bid be­low Medi­care’s rate, they can re­turn some of that to ben­e­fi­cia­ries in the form of added ben­e­fits.

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