Some Medicare Advantage Plan (hereafter simply "Plan") issuers are quietly and carefully adding home-based and community-based long-term care (LTC) benefits for 2019, according to Allison Bell, ThinkAdvisor's insurance editor. According to an excellent ThinkAdvisor article, officials at the Centers for Medicare and Medicaid Services (CMS). estimate that about 1.5 million of the 2019 enrollees, or 7.5% of Medicare Advantage plan enrollees, may have access either to support services in the home or community, or to extra benefits designed to help enrollees cope with the burden of diabetes or other chronic conditions. CMS officials have not, however, estimated how many enrollees might have access solely to the new home- or community-based services.
A previous blog article discussed these changes; see the article entitled, "Trump Administration Embraces Aging In Place- 2019 Advantage Plans Permitted to Incorporate Long Term Care," available by clicking here.
In Arizona and California, for example, units of Anthem Inc. are openly stating that they will use the new flexibility to beef up the benefits offered by some plans. Enrollees in certain Anthem plans will have access to what amount to LTC benefits provided for a short period of time:
- Three meals delivered per day for up to 42 days.
- Four four-hour shifts of in-home assistance with daily living activities, such as laundry.
- 40 hours of respite care for caregivers per year.
- One visit per week for adult day care center services, for older adults who need supervision.
- Health care appointment transportation services.
Traditionally, commercial insurers have referred to benefits for small amounts of LTC-type services with terms such as “convalescent care benefits,” or “short-term care benefits.” SCAN Health Plans of Long Beach, California, says it will offer new in-home benefits through most plans in Southern California, but it’s not easy to tell which new benefits will be related to the new rules.
UnitedHealth Group Inc.’s UnitedHealthcare unit says it will make telemedicine services available to 1.7 million enrollees through phones and computers, and health-related transportation services available to 1.7 million enrollees. The company is also offering a care management and care planning service for caregivers to most of its Medicare Advantage plans. It’s not clear from the company’s 2019 plan announcement whether those beneits are related to the new CMS rules.
Lack of clarity is a real problem. Unfortunately, for someone looking at the CMS 2019 Plan Information or even the plan issuers’ own benefits summary sheets, it is not easy to tell which plans will take advantage of the new CMS benefits flexibility. Moreover, the value of these additional services, and possible resulting costs are difficult for a lay person to evaluate. For these reasons, we strongly urge clients to establish a relationship with a trusted advisor. Locally, many of our clients use the advisors at Harding, Harding & Associates.
Traditionally, Medicaid has been the government health program that pays for nursing home care. Federal rules have blocked Medicare from paying for long-term care. Medicare has paid for skilled nursing care for people recovering from serious acute health care problems, and promised to pay for limited home health care services.
But Medicare has not paid for nursing home care for people who are in a nursing home simply because they are frail or have trouble with the activities of daily living, such as bathing or eating. Medicare has also avoided paying for other types of in-home services, such as help with cleaning or laundry, that might help keep older people in their homes.
In May, CMS said it would change Medicare Advantage benefits rules, to give issuers ways to offer new benefits for the “social determinants of care” that might help reduce overall medical spending. Officials suggested, for example, that, in some cases, spending a little money on transportation services or meal delivery for someone with serious health problems might be a good way to avoid spending a lot of money on hospital care.
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