Supplemental Long-Term Care Benefits Are Now Permitted in Medicare Advantage Plans
Guest article by Danielle Kunkle Roberts
Throughout our working lives, we know that someday when we retire, we’ll have Medicare to help us with our healthcare needs during our golden years. However, many people aging into Medicare each year are surprised to learn that Medicare doesn’t cover custodial care or long-term care. These are services that patients must pay for privately.
Last year, however, Medicare announced that starting this year in 2019, Medicare Advantage insurance carriers will be given more flexibility to incorporate supplemental benefits that are often associated with long-term care. Here’s what you should know about Medicare Advantage plans what you might expect to see in the new supplemental benefits going forward.
Medicare Advantage Part C Plans
Medicare Advantage plans were created under the Balanced Budget Act of 1997. They are an alternative to Traditional Medicare. People who sign up for a Medicare Advantage plan will receive their Part A and B healthcare services from a private insurance company (instead of from the federal government).
These plans have been growing in popularity because they often offer lower premiums than traditional Medigap plans. Approximately one-third of all Medicare beneficiaries are now enrolled in a Medicare Advantage plan. The plans are paid by Medicare to take on the health risk of each member, so the insurance companies set low premiums to attract people into the plans.
Most Advantage plans have either HMO or PPO networks of providers. Members pay copays and/or coinsurance to their in-network healthcare providers at the time they receive services.
One feature of Advantage plans is that insurance companies can build in “extras” that are not part of original Medicare. It’s not unusual to see preventive dental benefits or routine vision benefits like eye exams included. Some plans also include gym memberships or gym discounts.
New Home Health/LTC Benefits Now Permitted
When Medicare announced in 2018 that it would permit Advantage plans to include new supplemental, the reason was that they might help to reduce emergency room visits for people with chronic illnesses. These benefits are also likely to help elderly beneficiaries maintain their independence for as long as possible.
Some of the benefits that carriers can begin to include are:
- Safety devices in your home, such as wheelchair ramps or grab-bars in the bathroom
- Short-term support care or respite care for full-time caregivers
- Adult day-care services
- Home-based palliative care to reduce symptoms of members who are terminally ill
- In-home personal support to assist members with ordinary daily living activities
- Home safety modifications like bathroom grab bars, wheelchair ramps, and stair rails
- Transportation to and from medical services
- Delivery of meals to you at home
While a Medicare Advantage plan can’t directly pay for assisted living, the plan could incorporate any of these new supplemental benefits to help someone who is chronically ill be able to stay in their own homes for month or years longer than if they did not have access to such services.
The announcement regarding these new benefits was first made last April. While around 270 plans incorporated some of these benefits for 2019, many Advantage plans didn’t have time to build in these new benefits for 2019. We expect to see more of them being included in the 2020 plan designs.
When plans must offer these services to members equally, there are requirements to qualify for them. The services must be documented as medically necessary and not just for comfort. They must also be recommended or ordered by a Medicare doctor. While plans can offer the benefits, they cannot use them to induce enrollments into the plan.
As healthcare costs continue to go up, we may see more Medicare beneficiaries choose Medicare Advantage plans due to both lower premiums and new benefits available like these we have discussed.
Danielle Kunkle Roberts is a member of the Forbes Finance Council and co-founder at Boomer Benefits, a where she and her team help Medicare beneficiaries navigate Medicare. You can learn more at Boomer Benefits or connect on Twitter.
Glad to hear that, Kathy! We are interested to see how many plans begin to incorporate these into their benefit designs next year.
This is great news we hope that Medicare will offer to all older adults not just Advantage plan users. It is important that seniors ask for all of the benefits for which they are entitled especially those new items never before covered. Thanks for the update!