BY TIMOTHY BOONE
| STAFF WRITER OCT 6, 2019 - 9:15 PM
Medicare Advantage
customers will soon be able to choose from new insurance benefits that go well
beyond the usual coverage of doctor visits and other care in an effort to
improve their health and prevent costly medical problems.
Pest control, food for a
service dog, pharmacy staples such as aspirin and toothpaste, in-home personal
care to help with dressing and bathing, acupuncture and therapeutic massage
treatments, sessions with nutritionists and assistive devices such as shower
stools are among the new supplemental health benefits that privately run
versions of the government’s Medicare program could be offering starting in
2020. Enrollment for plans runs from Oct. 15 to Dec. 7.
Jane Sung, a senior
strategic policy adviser with the AARP Public Policy Institute, said the new
services are all part of an effort to address the health of Medicare Advantage
enrollees from a more complete perspective.
“If you address issues
that affect health, such as meals and support for care givers, it goes a long
way toward improving overall health,” she said. “That can save the program more
money.”
Medicare Advantage plans
already offer extras such as dental benefits, vision coverage or gym
memberships that regular Medicare doesn’t provide. But Medicare Advantage can
restrict access to a network of doctors or hospitals. Medicare doesn't have
those restrictions.
About a third of the
people on Medicare opt for Medicare Advantage plans, according to the nonprofit
Kaiser Family Foundation. In mid-2017, there were nearly 170,000 Medicare
Advantage customers in Louisiana, according to a Kaiser report.
The federal government is
giving Medicare Advantage plans more leeway to pay for things they’d ordinarily
never cover. The new supplemental benefits aim to help people with chronic
diseases or certain health issues stay healthy when they aren’t seeing a doctor
or receiving care.
“Medicare has made a
concerted effort to innovate more health and wellness programs,” said Mitch
Lubitz, a spokesman for Humana, the largest Medicare Advantage provider in
Louisiana.
But the items may not be
available to all Medicare Advantage enrollees. The pest control, for example,
might be available only to customers with chronic conditions that are made
worse by bedbugs. Meetings with nutritionists to help develop a healthy diet
are only covered if the person has a qualified condition, such as diabetes.
In-home personal care is available for people with conditions that limit their
daily living activities.
These new benefits will
only be available through Medicare Advantage plans, not regular Medicare, and
insurers are not required to offer them. Whether they do can depend on what
they think their customers need to stay healthy.
Aside from these
supplemental offerings, many plans also will provide telemedicine benefits to
help patients connect remotely with doctors and other care providers.
Nick Karl, vice president
of sales for UnitedHealthcare, which also owns Peoples Health and is the second-largest
Medicare Advantage provider in Louisiana, said some plans even reimburse people
for part of their Medicare Part B premiums, freeing up some of their money.
“Socioeconomic status matters,” he said. “People are not having to make a
decision between paying for their drugs and putting a meal on the table. That’s
going to cause better health outcomes.”
Martin Esquivel helped
Healthy Blue — a collaboration between Blue Cross Blue and Shield of Louisiana
and Anthem — develop its Medicare Advantage plans. He said some expanded
services have been offered since the start of 2019, such as home helpers. It's
too early to see what sort of impact those services have had so far, but
Esquivel said the utilization fits in with the early projections.
“The Centers for Medicare
and Medicaid Studies created the flexibility guidance so we could offer more
unique and tailored types of benefits,” he said. “Medicare is designed to be
reactive. You have a health issue, a claim gets submitted, it gets paid …. This
is shaping the program differently to save money and create a better
experience.”
Consumers need to do
their homework when they are looking at the wide range of new benefits, said
Vicki Dufrene, senior health director for the Louisiana Department of
Insurance. For example, the Healthy Blue Essential Extras package allows
customers to choose from one of 10 supplemental services, including 64 healthy
meal deliveries a year, 60 trips to health-related appointments, a fitness
tracker or weekly trips to adult day center services.
“Some of these extras are
not offered to every single individual, so you need to do research and make
sure you meet the qualifications,” she said.
And while some of the new
services are useful and can help a patient feel better, they need to be weighed
against the other factors that go into choosing a Medicare Advantage plan, such
as prescription coverage and if your doctor is included in the network, Dufrene
said.
Seniors with any
questions about Medicare Advantage plans can call the Department of
Insurance at (800) 259-5300, check with their local Council on
Aging or regional groups such as the Capital Area Agency on Aging, the Jefferson Council on Aging, the New Orleans Council on Aging or
the Cajun Area
Agency on Aging.
Insurers started
marketing their Medicare Advantage plans last week. Customers still have about
a week to learn about any coverage changes or added benefits before the Oct. 15
start of the annual open enrollment period. Shoppers will have until Dec. 7 to
enroll, switch to another Medicare Advantage plan or opt for regular Medicare
and add prescription drug coverage for 2020.
After that, Medicare
Advantage customers who regret their decision can make one change in the first
three months of 2020. That second window applies only to those who already have
a Medicare Advantage plan.
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