For 2020, some
policies will offer new, nonmedical coverage. Enrollment ends Dec. 7
By FRED RICCARDI Published: Nov 18, 2019 9:23 a.m. ET
This article is
reprinted by permission from NextAvenue.org.
Beginning this year and continuing into 2020,
Medicare Advantage plans (ones from private insurers) have increased
flexibility to provide coverage for what the government calls supplemental
benefits. These are services otherwise excluded by law from what’s known as
Original Medicare coverage.
And Medicare Advantage plans for
2020 can begin covering supplemental benefits that aren’t primarily
health-related, specifically for people with chronic illnesses. These benefits
address environmental factors that may affect their health, functioning, quality
of life and risk levels. So you may be seeing plans offering people with
chronic ailments coverage for things like meal delivery, transportation for
nonmedical needs, home air cleaners, and heart-healthy food.
Now that it’s the heart of Medicare Open Enrollment season,
ending Dec. 7, if you or a loved one will be shopping for Medicare coverage for
2020, you’ll want to know about these new supplemental benefits and how to size
them up before choosing a plan.
Criteria for a chronic
condition for Medicare supplemental benefits
Having a chronic condition, according to Medicare rules,
means that you meet these three criteria:
·
You have at least one
medically complex chronic condition that is life-threatening or
significantly limits your health or function
·
You have a high risk
of hospitalization or other negative health outcomes
·
You require intensive
health care coordination
If you meet these criteria, a Medicare
Advantage plan may offer you one of the new benefits if the service or product
has a reasonable expectation of improving or maintaining your health or
function.
Since Medicare Advantage plans will be able to
create sets of supplemental benefits for people with specific chronic
illnesses, not every member of a particular plan will have access to the same
set of benefits. For example, a plan might cover services like home air
cleaning and carpet shampooing for members with severe asthma. So, someone
signing up for the plan who has severe asthma may be able to get that service
covered, while someone else who doesn’t have asthma, or whose asthma is mild,
may not.
Before enrolling in a Medicare Advantage plan
with new supplemental benefits for people with chronic conditions, contact the
insurer to learn if you’d be eligible for them, and if so, how to access the
coverage.
You can also read a plan’s Evidence of Coverage
or use the government’s Medicare Plan
Finder for 2020. And for help understanding a plan’s benefits,
contact your State Health Assistance Program by calling 877-839-2675 or visiting
the website for
these programs.
Questions to ask when
buying a Medicare Advantage plan
If you’re thinking of enrolling in a Medicare
Advantage plan with supplemental benefits, consider the following questions:
·
Is this service only
covered as a Medicare Advantage supplemental benefit or is it also covered
under Original Medicare? To find out, call Medicare (800-MEDICARE) or visit the
government’s Medicare site.
·
If I sign up for a
Medicare Advantage plan because it contains this benefit, will my health care
providers be in-network and will my prescription drugs be covered?
·
Is this benefit
offered to all enrollees in this Medicare Advantage plan; an optional benefit I
need to elect to receive or something just for plan members with chronic
conditions?
·
Do I meet the plan’s
coverage criteria to receive the supplemental benefit?
·
Is there a cost
associated with this benefit?
·
Are there any limits
or restrictions on covered supplemental benefits? For example, is there a set
number of rides for a transportation benefit or a dollar limit on eyeglasses?
·
Do I need to see
in-network providers, receive a referral or participate in a care management
program to be eligible for the benefit?
·
Are there excluded
services within this category of benefits?
·
Is this the most
cost-effective way for me to access these services?
In some cases, there may be no Medicare
Advantage plan in your area with supplemental benefits you could use. Or you
might find that Original Medicare offers better coverage of services that are
important to you. If so, you may still be able to receive some services that
Original Medicare does not cover. Here’s how:
Medigap plans: Generally, these plans, also known as Medicare
supplemental insurance, only pay secondary to Medicare when Medicare covers a
service. However, some also cover additional days of inpatient hospital care
and/or emergency medical services received outside of the U.S. which aren’t covered
by Original Medicare. Some Medigap plans also offer fitness benefits or other
targeted supplemental coverage in some states.
Medicaid: This is a federal and state program that provides health
coverage for certain people with limited income and assets. In some
states, Medicaid covers services that Medicare doesn’t, including
dental, vision, long-term care and transportation for health care. To learn
more about your state’s Medicaid program, contact your State Health Assistance
Program.
Reduced-cost or free clinics: For more information about these, check
out the resources at these sites: Needymeds.org, Healthcare.gov, Freeclinics.com and the Health & Human Services
department’s site, HHS.gov.
Donated dental service programs or dental
schools: Dentists in the
programs offer free dental services if you qualify. You may also be able to get
low-cost dental care at a dental school, where dental students work with
patients under the supervision of experienced, licensed dentists.
For more information about Medicare options,
you can visit Medicare
Interactive, the Medicare Rights Center’s free online resource.
Fred Riccardi is president of Medicare Rights
Center, a national nonprofit consumer service organization working to ensure
access to affordable health care for older adults and people with disabilities.
This article is reprinted by permission
from NextAvenue.org,
© 2019 Twin Cities Public Television, Inc. All rights reserved.
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