Q. I read somewhere that lots of changes are on the horizon for Medicare Advantage plans in 2019. What are some of the new services being added, and when will I have an opportunity to change to a different plan that has more of what I need next year? Thanks for your help!
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A. 2019 is almost here, and as you mentioned, there are lots of changes to Medicare Advantage (MA) plans that could create more health care and elder care options for seniors in the new year.
The Centers for Medicaid and Medicare Services have allowed MA plans to cover a broad array of health services to improve the health and well-being of seniors. To accomplish this, in the new year, insurance companies will be able to offer a host of new benefits within their MA plans. Those benefits include meal delivery after a hospital stay, transportation to providers, in-home care, and more.
Here are details on some of the elder care changes you may see in certain MA Plans.
• Meals after hospitalization: Certain MA plans added a benefit that will allow a member who has been hospitalized 40 meals with Meals on Wheels after discharge. Or, if they have a chronic condition, the plan could offer ongoing meals that support the nutritional needs of that member’s chronic condition.
• Loneliness visit: If from a clinician standpoint a MA member seems to be isolated, certain plans have added a loneliness visit so that the member would have a person talking to them and meeting them while they are having a meal visit.
• In-home care services: Last week, a policy shift was finalized in a call letter issued by the Centers for Medicare & Medicaid Services (CMS) regarding in-home care services. In the past, MA plans (and traditional Medicare) were never allowed to cover “daily maintenance” types of care, but that standard has now been relaxed. Starting in 2019, the private-sector insurance companies that administer MA will be allowed to cover certain types of non-skilled in-home care. What will actually be covered under any given plan remains to be seen, and the cost of these additional services in the form of additional premiums also remains to be seen.
• Transportation Services: Certain MA companies have added transportation services to their plans so that members can better access their physicians and get rides to fitness centers.
• Telehealth: Now through the new rules and regulations, MA companies are allowed to support telehealth visits, and a telepsych benefit is being added. The telepsych benefit is still in the works as the number of psychiatrist are limited.
Only a small percentage of MA plans are offering these new supplemental benefits next year, according to data from AARP. It is a wise idea to shop around and look at the costs and benefits of each plan to find one that’s best for you.
Want to Switch to a Different Medicare Advantage plan? You Will Have an Opportunity Soon!
Starting in early 2019, you’ll have the opportunity to switch to a different MA Plan, and you’ll have more time to enroll (or disenroll). The Medicare Advantage Disenrollment Period (January 1 – February 14 every year) will be replaced with a different arrangement. The new MA Open Enrollment Period will now run from January 1 – March 31 every year. If you’re already enrolled in a MA plan, you’ll have a one-time opportunity to:
• Switch to a different MA plan;
• Drop your MA plan and return to Original Medicare, Part A and Part B;
• Sign up for a stand-alone Medicare Part D Prescription Drug Plan (if you return to Original Medicare). Most MA plans include prescription drug coverage already. Usually you can’t enroll in a stand-alone Medicare Prescription Drug plan if you already have a MA plan, but there are some situations where you can. Call your MA plan if you have questions.
Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
Two Local Senior Living Providers Have Started Medicare Advantage Plans
According to Senior Housing News, “Already, two of the largest senior living operators in the nation—McLean, Virginia-based Sunrise Senior Living and Catonsville, Maryland-based Erickson Living—have started their own Medicare Advantage plans.”
New Changes are Also on the Horizon for Medicare Part D
Speaking of Medicare-related changes, there are also changes coming for Medicare Part D, the prescription drug benefit. The coverage gap, known as the donut hole, is going away for brand-name drugs in 2019. The gap happens when enrollees with high-cost prescriptions reach a certain level of spending in one year and have to pay more for their drugs. Then, once their out-of-pocket spending hits a second threshold, catastrophic coverage kicks in and they don’t have to pay as much. The donut hole for generic drugs is scheduled to close in 2020.
Medicare (or Medicare Advantage plans) Does Not Cover Long-term Care
Even with the new benefits and changes described, one thing remains the same: Medicare does not pay one penny, ever, for long-term care (also called custodial care), if long-term care is the only care needed (most nursing home care is custodial care) — see https://www.medicare.gov/coverage/long-term-care.
Medicare pays for health care for people age 65 years and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease. Medicare only covers medically necessary care and focuses on acute care, such as doctor visits, drugs, and hospital stays. Medicare also covers short-term care and rehabilitation, such as physical therapy to help you regain your function, after injuries such as a fall or a stroke. More of these short-term care and rehabilitation services can now be provided at home by MA plans under the new rules, but this is still short-term care, not long-term care.
Long-Term Care and Elder Care Planning in Northern Virginia, Maryland, and Washington, DC
Long-term care and elder care planning involves long-term help with activities of daily living such as bathing, dressing, and using the bathroom, or supervision needed by those suffering from dementia.
Medicaid Asset Protection Planning in Northern Virginia, Maryland, and Washington, DC
For long-term care, the main government benefit is Medicaid, but Medicaid laws are the most complex laws in existence. There are strict financial requirements that must be met in order to qualify for Medicaid, including the requirement of having less than $2,000 of countable assets to your name. Nevertheless, with proper Medicaid asset protection planning, almost everyone can qualify for Medicaid when needed, without having to go broke by first spending down your life savings. If you or a loved one is nearing the need for long-term care or already receiving long-term care, please call us to make an appointment for an initial consultation:
Medicaid Planning Attorney Fairfax: 703-691-1888
Medicaid Planning Attorney Fredericksburg: 540-479-1435
Medicaid Planning Attorney Rockville: 301-519-8041
Medicaid Planning Attorney DC: 202-587-2797
About Evan H Farr, CELA, CAP
