In 2020, Medicare beneficiaries will have more
opportunities to join Medicare Advantage (MA) managed care plans that offer limited
personal supports and services such as home care, non-medical transportation,
nutrition programs, and home modifications. The benefits, first allowed by the
federal government for 2019, are not full-blown long-term care, but they do
provide critical services and supports that may make it easier for older adults
with chronic conditions to stay in their homes.
Enrollment for 2020 begins on Oct. 15 and runs
through December 7. Medicare participants will pay no additional premiums for
the additional benefits, nor will Medicare pay the plans extra money to run the
programs. Plans expect that providing the additional services eventually will
lower enrollees’ use of high-cost medical care such as hospital stays.
Return on investment
While that return on investment remains
uncertain, plans seem more enthusiastic about adding the benefits for 2020.
The Centers for Medicare and Medicaid Services (CMS) estimates that
about 500 plans will offer about 2.6 million enrollees health-related
supplemental benefits such as adult day programs or caregiver supports. About
250 plans will offer non-medical supplemental benefits to about 1.2 million
enrollees. These include services ranging from rides to the grocery store to
pest control.
The expansions are the result of two parallel
changes in the law enacted in 2018. CMS adopted new rules (revised for this year) that allowed plans to offer
additional “primarily health-related” supplemental medical benefits that
maintain or improve overall health. At about the same time, Congress adopted the CHRONIC Act, a law that allowed plans to
offer non-medical services to members with chronic conditions. The new law also
gave plans important flexibility that makes it possible for them to tailor
benefits to people with specific needs. For instance, plans could offer
nutrition coaching to members with diabetes without having to offer similar
services to all its members.
Modest extra benefits
The extra benefits are very modest.
Independent analysts estimated that were worth only $30-$50 a month in 2019,
and they are unlikely to be much higher in 2020. Crucially, however, they begin
to break down the half-century barrier between health care, which Medicare does
pay for, and supports and services, which it generally does not.
One early adopter of the MA expansion was Anthem Inc. and
its affiliates. This year, it offered supportive services in about a dozen
states, but in 2020 it is expanding the programs to 16 states. It also is
increasing the kinds of services it offers. And it expects to roughly double
the number of enrollees eligible for the added benefits.
Anthem offers two basic benefit packages. In
the version most widely available, members choose in advance one benefit from a
menu of services such as transportation, alternative medicine, in-home
supports, and the like. In the other, much smaller alternative, participating
members have access to all available services. Members can use an Anthem
case manager to help make their choices.
The most popular benefits for 2019:
Transportation and alternative medicine such as massage therapy. For next year,
Anthem is adding services such as nutritional counseling, home delivery of food
staples, pest control, and even support for service animals.
More experience needed
Anthem was pleasantly surprised by the number
of members who enrolled for 2019—about 165,000 signed up for the
pick-from-the-menu version and about 65,000 for the full suite of services. And
while some analysts feared that only the highest risk seniors would enroll in
the program, Anthem found that was not the case. The risk profile of those
receiving supplemental benefits was similar to overall MA enrollees.
One year of experience was not enough for
Anthem to conclude that the new social supports will reduce medical costs or
improve outcomes for the participating members. Yet, the results were positive
enough that the insurer expanded the program for 2020. Anthem’s vp of product
design, Martin Esquivel, calls the overall 2019 experience “quite
fruitful."
Other plans are enhancing MA benefits as well.
Cigna, which is expanding its overall MA business, will offer benefits such
as non-medical transportation services in Arizona and
Pennsylvania. The Pittsburgh-based UPMC Health Plan will offer members
with diabetes special health coaching.
Overall, about one-third of Medicare
beneficiaries are enrolled in MA plans this year. CMS announced in late
September that average 2020 premiums are expected to decline to $23 from $26.87
in 2019. CMS projects about 24.4 million people will enroll in MA plans next
year, up from 22.2 million this year.
It will take a few more years for consumers,
plans, and policymakers to learn how well the model works, and whether it can
both save plans money and improve health outcomes for members. But, at least
for now, this important experiment appears to be growing.
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