The new
benefits may not be much like short-term care insurance, let alone LTCI.
Medicare Advantage program managers abruptly
encouraged insurers to jam a few non-medical “supplemental benefits” into their
benefits packages for 2019.
Some insurers added the kinds of benefits that
might be covered by a short-term care insurance or long-term care insurance
(LTCI) policy, such as adult day care services, homemaker services, and support
for caregivers.
Officials at the Centers for Medicare and Medicare
Services (CMS) recently put more fleshed-out rules for “chronic care”
benefits in a draft version of a bidding document for the 2020 Medicare
Advantage program.
Insurance company executives now have time to
decide, in an orderly way, if they want to build chronic care benefits into
their 2020 Medicare Advantage plan benefits menus.
In theory, the chronic care benefits provision
could be the start of Medicare creeping into the long-term care benefits
business, or a dead end, or the beginning of an era in which Medicare
simply provides want amounts to small promotional samples of LTCI-type samples.
Medicare sample-size LTC benefits could help sell consumers on the idea of
buying full-size short-care insurance or LTCI policies.
The recent Intercompany Long Term Care
Insurance Conference presented a session on the topic.
The speakers included Howard Gleckman of
the Urban Institute, Jay Greenberg of NCO Services, and Anne Tumlinson, a
consultant who previously served as a senior vice president at Avalere Health.
Here’s a look at five speaker insights about
the new Medicare Advantage chronic care benefits, drawn from the speakers’
slidedeck.
1. The 2020 chronic care benefits seem
to replace the 2019 supplemental benefits, not supplement them.
The benefits offered in new short-term care
insurance and LTCI policies tend to hold fairly steady from year to year.
Consumers who buy LTCI policies can lock in
benefits for many years.
The new Medicare Advantage chronic care
benefits “can vary from year to year,” according to the Medicare Advantage LTC
session speakers.
2. The number of insurers offering chronic
care benefits seems likely to grow.
In part because the opportunity appeared with
such little advance notice, only a limited number of issuers submitted bids in
2019, according to the Medicare Advantage LTC speakers.
Issuers saw the 2019 supplemental benefits
opportunity as a kind of pilot program.
“More will participate in 2020,” according to
the session speakers..
Issuers see value in the idea of investing a
little money in non-medical support services, such as a little help with
transportation, laundry or caregiver respite care, to hold down preventable use
of expensive acute medical services, according to the session speakers.
3. Issuers do worry about the risk that sicker
patients will choose the plans that offer the new chronic care benefits.
Many issuers would like to see a better
risk-adjustment system in place before they add the new chronic care benefits,
according to the session speakers.
4. Funding will be sparse.
One challenge is that issuers still need to
hold rates down, and another is that issuers will feel pressure to sweeten
important benefits with broader appeal, such as dental benefits, according to
the session speakers.
The budget constraints could put tight limits
on chronic care benefits value. This year, for example, the companies that have
added adult day care benefits cover just a few days of adult day care. The
coverage is much skimpier than the coverage available in typical convalescent
care policies, or other short-term care insurance policies.
5. Marketing the benefits will be
complicated.
Issuers are supposed to target the new
benefits at enrollees at high risk of needing expensive, preventable medical
care.
That means that only certain enrollees will
end up qualifying to use the benefits, which means that highlighting the
benefits in marketing materials could mislead the many consumers who might have
a need for the types of services covered but will not actually qualify to use
their Medicare Advantage coverage to pay for the services, according to the
session speakers.
Resources
More information about the Medicare Advantage
chronic care benefits session, including a link to the presentation slidedeck,
is available here.
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