The options may be limited in 2019 but that's likely to change
in 2020 and beyond
Additional pieces of coverage for Medicare
Advantage plans may help solve the puzzle of paying for long term care.
If you use Medicare,
you probably feel that it does a pretty good job of covering your medical
costs. That’s the case for most people, since the government-run insurance plan
covers about 80% of outpatient expenses and even more for inpatient expenses.
However, you may not
realize that Medicare does not cover one major expense that might be looming
for you or your spouse: long-term care. Often, by the time that people realize
this, it’s too late or too expensive to pick up long-term care insurance.
And while people with
very low incomes can qualify for Medicaid to help them with long-term care
expenses, everyone else is left to privately pay for their assisted living
centers and nursing home care.
The long-term care
gap
About two-thirds of
those eligible for Medicare enroll in Original Medicare, or Medicare Parts A and B, which covers
hospital and medical costs. Most people who enroll in Original Medicare also
opt for a Medicare Part D plan, which covers prescription drugs.
Another option is to
choose a Medicare Advantage plan: These plans, offered by private
insurers, offer the same coverage as parts A, B and D, and can also include
ancillary benefits that Original Medicare does not provide, such as dental,
vision and hearing expenses or gym memberships.
Until recently, however,
neither the Original Medicare or Part C offered any coverage for long-term
care. That changed last year, when the Centers for Medicare and Medicaid
Services (CMS) announced that they would begin allowing Medicare Advantage
plans to provide some supplemental long-term care services to their members the
following year.
The new coverage
options
Starting in 2019,
Medicare Advantage plans had the option to build in some supplemental benefits
that fall into the realm of home and community-based long-term care.
Some of the new
long-term care options include:
·
Adult
day-care services
·
In-home
assistance with custodial care or activities of daily living
·
Respite
care benefits for caregivers
·
Home
safety modifications like bathroom grab bars, wheelchair ramps, and stair rails
·
Non-emergency
transportation services so that members can get to their doctor’s appointments
·
In-home
meal delivery
The goal of these
newly allowed benefits is to prevent costly hospitalizations and help
chronically ill beneficiaries continue living independently for months or even
years beyond what they have been able to do in the past.
Other new benefits
A few other key new benefits were also announced last year:
Better coverage for
brand-name drugs:
Starting this year, the dreaded “donut hole” for prescription drugs will be
eliminated.
When Part D was first
introduced in 2006, insurance companies could and did charge members 100% of
the cost of their brand name prescription drugs when they reached the coverage
gap (or donut hole). The Affordable Care Act changed this and the percentage of
the cost that members are responsible for has been slowly falling over the last
few years.
This year, members pay
no more than 25% of the cost of their brand-name drugs in the gap in 2019.
A new open enrollment
period:
This year, the Open Enrollment Period from January 1st to March
31st each year has been reinstated.
This allows Medicare
beneficiaries enrolled in Medicare Advantage plans to either change from one
Medicare Advantage plan to another, or they can disenroll from their Medicare
Advantage plan and return to Original Medicare and a standalone Part D drug
plan.
So if a beneficiary
makes a mistake or finds that they don’t like their plan for any reason, they
can make a one-time plan change during this period. It’s a welcome change that
may make some beneficiaries feel less hesitant to try an Advantage plan, knowing
that they won’t necessarily be locked in.
Beneficiaries should
keep in mind, though, that when they return to Original Medicare from an
Advantage plan, they may have to answer health questions and go through medical
underwriting in order to add that plan.
The future of
long-term care
While the new
long-term care benefits will appeal to many people, unfortunately existing
plans were initially slow to build in the new benefits this year.
This was likely due
to limited time to incorporate the new benefits between the time of the CMS
announcement and deadline for plan designs to be submitted to Medicare for 2019
year.
However, given the
expected popularity of these changes, it is hopeful that more plans will
incorporate some of these supplemental benefits in 2020 and beyond.
As costs of
healthcare continue to inflate, it’s likely that more and more beneficiaries
living on fixed income will begin to gravitate toward Medicare Advantage plans
that offer lower premiums.
These potential new
benefits and additional window to change their minds about their plan are
certain to increase the number of beneficiaries who choose a Medicare Advantage
plan as their coverage in the coming years.
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