Witnesses asked why Medicare Advantage plans should offer more
benefits.
Medicare Advantage program managers recently
announced that they want to let issuers add chronic care benefits to the
2019 benefits packages.
Witnesses who appeared today at a hearing in
Washington on the Medicare Advantage program welcomed the idea of adding
chronic care benefits to the benefits package, but some suggested that limiting
access to those benefits to Medicare Advantage plan enrollees might be unfair
to people who stick with the traditional Medicare fee-for-service program.
Karoline Mortensen, a health sector management
researcher from the University of Miami business school, was one of the
witnesses who raised the idea that adding chronic care benefits to the Medicare
Advantage program, but not to the traditional Medicare fee-for-service program,
could lead to concerns about fairness.
“Make sure traditional fee-for-service
enrollees are not left out,” Mortensen testified.
The House Ways & Means health subcommittee
organized the hearing. Links to resources related to the hearing, including a
recording of the hearing video, are available here.
The 2019 Benefits
Package Change
A Medicare Advantage official wrote April 27,
in a memo sent to potential 2019 Medicare Advantage plan issuers, that managers
will let issuers add a wide range of chronic care benefits as “supplemental
benefits,” by changing how they interpret the term “supplemental benefits.”
The Medicare Advantage program lets private
insurers offer Medicare enrollees an alternative to traditional Medicare
coverage. To make shopping for coverage as simple as possible, and to keep
public plan coverage from crowding out private forms of insurance, Medicare
Advantage program managers have traditionally kept issuers from including
chronic care benefits in their benefits packages.
In recent years, however, many commercial
insurers have pulled out of the private long-term care insurance (LTCI) market,
and executives from some of the issuers still in the market have suggested at
LTCI industry events that the federal government should fill the long-term care
(LTC) benefits gap by forming public-private LTC partnerships.
Medicare Advantage program managers have
justified the idea of letting chronic care benefits into Medicare Advantage by
saying the benefits could address the “social determinants” of health, such as
access to appropriate food. Officials have said that a plan issuer could choose
to cover adult day care services, home modification services, and almost any
other form of chronic care other than nursing home care or home meal delivery.
The Hearing
Mortensen suggested at the hearing that even
services that help low-income Medicare Advantage plan enrollees get groceries
might be considered an important form of health care improvement service.
“If you don’t have food on your table, that
could be a significant factor in your health outcomes,” Mortensten said.
Daphne Klausner, a senior markets
executive from Independence Blue Cross, a nonprofit Philadelphia-based
carrier, said her company would like to find a way to provide a nutrition
benefit for recently discharged hospital benefits. She said she would also like
to find a way to build dental benefits and hearing aid benefits into her
company’s benefits.
But Mortensen noted that one challenge for
Medicare Advantage managers and observers has been figuring out how to build
adjustments for enrollees’ socioeconomic status into plan quality ratings.
The socioeconomic status adjustment factors
built into the ratings so far have had surprisingly little effect on quality
ratings, and that has been a concern for many, Mortensen said.
She said Medicare Advantage program
managers need to find good ways to measure the effects of investments in
the social determinants of health on people’s health.
Andrew Toy, chief technology officer at Clover
Health, said benefits for technology could be important to helping to keep
people with chronic health problems in their homes.
Clover Health already provides enrollees with
chronic health problems a smart speaker than can connect an enrollee with a
call center with one push of a button, and it also provides in-home social work
with a partnership, Toy said.
Allowing more flexibility for telehealth
benefits could also help plan issuers meet Medicare Advantage provider network
adequacy standards, especially in rural areas, Toy said.
Also at the hearing, Jack Hoadley, a witness
from the Georgetown University Health Policy Institute, said he believes
consumers need one-on-one help with understanding and choosing Medicare
Advantage plans, not just access to the MedicareAdvantage plan selection
website.
The Medicare Plan Finder is a valuable tool,
but it “really represents technology of 10 or 15 years ago,” Hoadley said. “It
hasn’t been modernized and updated.”
One weakness is that a consumer may have a
hard time comparing the benefits and out-of-pocket costs for a Medicare
Advantage plan with the benefits and out-of-pocket costs for a package of
traditional Medicare with Medicare supplement insurance, Hoadley said.
Allison Bell, ThinkAdvisor's
insurance editor, previously was LifeHealthPro's health insurance editor. She
has a bachelor's degree in economics from Washington University in St. Louis
and a master's degree in journalism from the Medill School of Journalism at
Northwestern University. She can be reached at abell@alm.com or on Twitter at
@Think_Allison.
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