by Susan Jaffe, Kaiser Health News @CNNMoney April 4, 2018: 5:30 PM ET
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 when new federal rules take effect next year.
On Monday, the Centers for Medicare &
Medicaid Services expanded how it defines the "primarily
health-related" benefits that insurers are allowed to include in their
Medicare Advantage policies. And insurers would include these extras on top of
providing the benefits traditional Medicare offers.
"Medicare Advantage beneficiaries will have
more supplemental benefits, making it easier for them to lead healthier, more
independent lives," said CMS Administrator Seema Verma.
Of the 61 million people enrolled in Medicare
last year, 20 million have opted for Medicare Advantage, a privately run
alternative to the traditional government program. Advantage plans limit
members to a network of providers. Similar restrictions may apply to the new
benefits.
Many Medicare Advantage plans already offer some
health benefits not covered by traditional Medicare, such as eyeglasses,
hearing aids, dental care and gym memberships. But the new rules, which the
industry sought, will expand that significantly to items and services that may
not be directly considered medical treatment.
CMS said the insurers will be permitted to
provide care and devices that prevent or treat illness or injuries, compensate
for physical impairments, address the psychological effects of illness or
injuries, or reduce emergency medical care.
Although insurers are still in the early stages
of designing their 2019 policies, some companies have ideas about what they
might include. In addition to transportation to doctors' offices or better food
options, some health insurance experts said additional benefits could include
simple modifications in beneficiaries' homes, such as installing grab bars in
the bathroom, or aides to help with daily activities, including dressing,
eating and other personal care needs.
"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," said Alicia Kelley, director of Medicare sales for Capital
District Physicians' Health Plan, a nonprofit serving 43,000 members in 24
upstate New York counties.
Even though a physician's order or prescription
is not necessary, the new benefits must be "medically appropriate"
and recommended by a licensed health care provider, according to the new rules.
Many beneficiaries have been attracted to
Medicare Advantage because of its extra benefits and the limit on out-of-pocket
expenses. However, CMS also cautioned that new supplemental benefits should not
be items provided as an inducement to enroll.
The new rules "set the stage to continue to
innovate and provide choice," said Cathryn Donaldson, of America's Health
Insurance Plans, a trade group.
"CMS is catching up with the rest of the
world in terms of its understanding of how we keep people healthy and well and
living longer and independently, and those are all positive steps," said
Ceci Connolly, chief executive officer of the Alliance of Community Health
Plans, which represents nonprofit health insurance plans. Some offer
non-emergency medical transportation, low-cost hearing aids, a mobile dental
clinic and a "grocery on wheels," to make shopping more convenient,
she said.
UnitedHealthcare, the largest health insurer in
the US, also welcomes the opportunity to expand benefits, said Matt Burns, a
company spokesman. "Medicare benefits should not be one-size-fits-all, and
continued rate stability and greater benefit design flexibility enable health
plans to provide a more personalized health care experience," he said.
But patient advocates including David Lipschutz.
senior policy attorney at the Center for Medicare Advocacy, are concerned about
those who may be left behind.
"It's great for the people in Medicare
Advantage plans, but what about the majority of the people who are in
traditional Medicare?" he asked. "As we tip the scales more in favor
of Medicare Advantage, it's to the detriment of people in traditional Medicare."
The details of the 2019 Medicare Advantage
benefit packages must first be approved by CMS and will be released in the
fall, when the annual open enrollment begins. It's very likely that all new
benefits will not be available to all beneficiaries since there is
"tremendous variation across the country" in what plans offer, said
Gretchen Jacobson, associate director of the Kaiser Family Foundation's Program
on Medicare Policy.
Kaiser
Health News (KHN) is a nonprofit news service covering health
issues. It is an editorially independent program of the Kaiser
Family Foundation that is not affiliated with Kaiser
Permanente.
CNNMoney (New York)First published April 4,
2018: 5:30 PM ET
http://money.cnn.com/2018/04/04/news/economy/medicare-advantage-benefits/index.html
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