Eyeglasses, hearing aids, dental treatment, and gym memberships are just a few of the health benefits that many Medicare Advantage plans already provide that are not covered by standard Medicare. But the new regulations, which the industry requested, will dramatically broaden that to include goods and services that might not necessarily be considered medical therapy.
When new federal regulations go into force the next year, new benefits for Medicare Advantage coverage could include home-delivered meals, nutritious foods, trips to doctor’s visits, and air conditioners for patients with asthma.
The definition of the “mainly health-related” features that insurers are permitted to add in their Medicare Advantage policies was enlarged by the Centers for Medicare & Medicaid Services (CMS) on Monday. And in addition to offering the conventional Medicare benefits, insurers would also include these extras.
CMS Administrator Seema Verma stated that “Medicare Advantage participants would have additional supplemental benefits, making it easier for them to lead healthier, more independent lives.”
Twenty million of the 61 million Medicare beneficiaries who were registered in the programme last year chose Medicare Advantage, a privately administered programme that is an alternative to the standard government programme. Members of advantage plans are restricted to a provider network. The new benefits may be subject to similar limitations.
Eyeglasses, hearing aids, dental treatment, and gym memberships are just a few of the health benefits that many Medicare Advantage plans already provide that are not covered by standard Medicare. But the new regulations, which the industry requested, will dramatically broaden that to include goods and services that might not necessarily be considered medical therapy.
According to CMS, insurers will be allowed to offer services and equipment that lessen the need for emergency medical care, treat or prevent disease or injury, make up for physical deformities, deal with their psychological repercussions, or compensate for physical disabilities.
While insurers are still in the planning stages for their 2019 plans, several businesses already have ideas for what they might contain. Some health insurance experts suggested that additional benefits could include simple home improvements like installing grab bars in the bathroom or aids to help with daily activities like dressing, eating, and other personal care requirements, in addition to transportation to doctors’ offices or better food options.
Alicia Kelley, director of Medicare sales for Capital District Physicians’ Health Plan, a nonprofit with 43,000 members in 24 upstate New York counties, said, “This will allow us to build off the existing benefits that we already have in place that are focused more on prevention of avoidable injuries or exacerbation of existing health conditions.”
The new benefits must be “medically appropriate” and recommended by a registered health care practitioner even though a doctor’s order or prescription is not required.
The additional benefits and cap on out-of-pocket costs of Medicare Advantage have drawn in a lot of beneficiaries. CMS did, however, issue a warning that additional extra benefits shouldn’t be offered as a recruitment tool.
Cathryn Donaldson of the trade group America’s Health Insurance Plans said that the new regulations “lay the stage to continue to innovate and provide choice.”
According to Ceci Connolly, CEO of the Alliance of Community Health Plans, which represents nonprofit health insurance plans, “CMS is catching up with the rest of the world in terms of its understanding of how we keep people well and well and living longer and independently. To make shopping more comfortable, some provide non-emergency medical transportation, affordable hearing aids, a mobile dentistry clinic, and a “grocery on wheels,” she said.
According to business spokesperson Matt Burns, UnitedHealthcare, the biggest health insurer in the U.S., likewise appreciates the chance to increase benefits. “Medicare benefits shouldn’t be one-size-fits-all,” he said, adding that more benefit design flexibility and rate stability allow health plans to deliver a more individualised level of medical treatment.
However, patient advocates are worried about people who would be left behind, like David Lipschutz, senior policy counsel at the Center for Medicare Advocacy. He questioned, “It’s excellent for those in Medicare Advantage plans, but what about the vast majority of those in regular Medicare?” “People with conventional Medicare suffer when we tip the scales more in favour of Medicare Advantage.”
It’s not a novel idea to attend to a patient’s social and medical requirements outside of the exam room. For instance, the California organisation The Institute on Aging provides elderly and persons with disabilities with physical, social, and psychological assistance. It offers a range of services to make their new life simpler, from kitchen supplies to wheelchair ramps, and has assisted people in San Francisco and Southern California in moving from nursing facilities to their own homes.
According to Dustin Harper, vice president for strategic partnerships at the institute, “by taking a more integrated approach to address people’s social and health needs, we have seen up to a 30 percent savings in health care costs compared to the costs of the same individuals before they joined our programme.” The organisation assists 20,000 Californians annually who are eligible for Medicare, Medicaid, the federal-state health insurance programme for low-income people, or both, including former nursing facility residents.
CMS also emphasised that a new federal law permits Medicare Advantage plans to provide benefits that are not primarily health-related for Medicare Advantage members with chronic conditions, in addition to the adjustments to supplemental benefits for the next year. According to CMS officials, the law and the agency’s modifications complement each other. In order to help plans distinguish between the two, they vowed to provide further information in the upcoming months.
