Groceries? Air Conditioners? – Extra Benefits for Medicare Advantage Policy Holders

Michelle recently had a discussion with her mother, Rose, about ways to make Rose’s house more comfortable and easier-to-navigate. Rose’s mobility isn’t what it used to be and she can no longer walk, and is unable to drive herself to the supermarket or to doctor’s appointments.

Michelle wants to help her mom improve her quality of life by making her home more accessible and by finding transportation options for Rose when she is not available to help. When it comes to accessibility, however, neither Michelle nor her mom can afford to make the changes to Rose’s home. Next year, Rose may get help from an unexpected source!

Medicare Advantage plans are now covering much more when new federal rules take effect next year. In fact, air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage coverage.

For those of you unfamiliar, Medicare Advantage is a private health plan option available to people with Medicare. Medicare Advantage plans are one of two main types of Medicare plans. The other type is referred to as original or traditional Medicare plans. They are fee-for-service plans managed by the Medicare program itself. Medicare Advantage plans, on the other hand, are managed by private insurance companies. These insurers are approved by and receive payment from the Medicare program.

The Medicare Advantage program has grown rapidly over the last decade, from nine million beneficiaries in 2008 to over 20 million enrolled today. Medicare beneficiaries are choosing MA for a variety of reasons, but primarily because the private plans are able to offer more coverage for lower cost sharing than what is available through original Medicare.

New Medicare Advantage Benefits on the Horizon

Last week, the Centers for Medicare & Medicaid Services (CMS) expanded how it defines the “primarily health-related” benefits that insurers can include in their Medicare Advantage policies. A provision included in the recently enacted budget law will now make it much easier for Medicare Advantage (MA) plans to offer more supplemental benefits within their plans. This will create new opportunities for plans and could result in MA beneficiaries receiving many new benefits.

Kaiser Health News reports that in 2019, Medicare Advantage plans might cover the following:

• Air conditioners for folks with asthma
• Home-delivered meals
• Transportation to medical appointments

This stems from one of two big changes that the Centers for Medicare & Medicaid Services (CMS) recently announced. The changes are:

1. A broader definition of benefits

CMS will increase the number of allowable supplemental benefit options to provide patients with benefits and services that may improve their quality of life and health outcomes.

Kaiser Health News notes that additional benefits that insurers may add to their Medicare Advantage plans for 2019 as a result of this change. For example, they could also include minor modifications to beneficiaries’ homes such as installing grab bars in the bathroom.

2. A higher payment rate

CMS also recently announced that it will increase its payment rate to Medicare Advantage plans by 3.4%, about twice what CMS previously projected.

Other Changes to Medicare Advantage Plans

New benefit flexibilities, coupled with the continued growth of the MA program, create the opportunity for MA plans to offer additional supplemental benefits that could include:

• Dietary and nutritional supplements;
• Home improvements that increase beneficiary safety;
• Respite, caregiver supports and companionship services;
• Medical safety interventions such as in-home medicine cabinet checks and expired medicine disposal;
• Transportation to pharmacies and wellness activities.

Medicare Does Not Cover Long-term Care

Even with the new benefits described, one thing remains the same: Medicare does not pay one penny, ever, for 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.

Long-term care 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.

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. However, with proper Medicaid asset protection planning, almost everyone can qualify for Medicaid when needed, without having to be broke or to first spend 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 a no-cost initial consultation:

Fairfax Medicaid Planning: 703-691-1888
Fredericksburg Medicaid Planning: 540-479-1435
Rockville Medicaid Planning: 301-519-8041
DC Medicaid Planning: 202-587-2797

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