Medicare Advantage Plans Cleared To Go Beyond Medical Coverage – Even Groceries


Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals might be one of the new benefits added to Medicare Advantage coverage when new federal rules take effect next year.

On Monday, the Centers for Medicare & Medicaid Services (CMS) expanded the way it defines the “primarily health-related” benefits that insurers are allowed to use in their Medicare Advantage policies. And insurers would include these extras on top of supplying the benefits traditional Medicare offers.

“Medicare Advantage beneficiaries may have more supplemental benefits making it easier for them to lead healthier, more independent lives,” said CMS Administrator Seema Verma.

Of the 61 million people enrolled in Medicare this past year, 20 million have chosen Medicare Advantage, a privately run option to the standard government program. Advantage plans limit members to a network of providers. Similar restrictions may affect the brand new benefits.

Many Medicare Advantage plans already offer some health advantages not included in traditional Medicare, such as eyeglasses, assistive hearing devices, dental care and gym memberships. However the new rules, that the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment.

CMS said the insurers is going to be able to provide care and devices that prevent or treat illness or injuries, make amends for physical impairments, address the psychological results of illness or injuries, or reduce emergency health care.

Although insurers are still in early stages of designing their 2021 policies, some companies have ideas about what they may include. In addition to transportation to doctors' offices or better food options, some medical health insurance experts said additional benefits could include simple modifications in beneficiaries' homes, such as installing grab bars within the bathroom, or aides to assist with day to day activities, including dressing, eating along with other personal care needs.

“This can let us build from the existing benefits that people already have in place which are focused more on protection against avoidable injuries or exacerbation of existing health problems,” said Alicia Kelley, director of Medicare sales for Capital District Physicians’ Health Plan, a nonprofit serving 43,000 members in 24 new york counties.

Even though a physician’s order or prescription is not required, the brand new benefits should be “medically appropriate” and recommended by a licensed health care provider, according to the new rules.

Many beneficiaries have been drawn to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits shouldn't be items provided being an inducement to enroll.

The new rules “set the stage to carry on to innovate and supply choice,” said Cathryn Donaldson, of America’s Medical health insurance Plans, a trade group.

“CMS is catching up with all of those other world in terms of its knowledge of the way we keep people healthy and well and living longer and independently, and those are positive steps,” said Ceci Connolly, ceo from the Alliance of Community Health Plans, addressing nonprofit health insurance plans. Some offer non-emergency medical transportation, low-cost hearing aids, a mobile dental clinic and a “grocery on wheels,” to create shopping easier, she said.

UnitedHealthcare, the largest health insurer within the U.S., also welcomes the opportunity to expand benefits, said Matt Burns, a company spokesman. “Medicare benefits should not be one-size-fits-all, and continued rate stability and greater benefit design flexibility enable health intends to provide a more personalized health care experience,” he said.

But patient advocates including David Lipschutz. senior policy attorney in the center for Medicare Advocacy, are concerned about people who might be left behind. “It’s ideal for the people in Medicare Advantage plans, but how about the majority of the those who are in traditional Medicare?” he asked. “Once we tip the scales more in support of Medicare Advantage, it’s towards the detriment of people in traditional Medicare.”

The information on the 2021 Medicare Advantage benefit packages must first be approved by CMS and will also be released in the fall, when the annual open enrollment begins. It’s very likely that new benefits won't be available to all beneficiaries as there is “tremendous variation over the country” in what plans offer, said Gretchen Jacobson, associate director of the Kaiser Family Foundation's Program on Medicare Policy. (Kaiser Health News is an editorially independent program of the foundation.)

This is among several vans that provides door-to-door service for seniors and adults with disabilities going to medical appointments and programs in the Institute on Aging in Bay area. (Credit: Susan Jaffe)

Addressing a patient’s health insurance and social needs away from doctor’s exam room isn’t a brand new concept. The Institute on Aging, for instance, is really a California nonprofit that offers health, social, and psychological services for seniors and adults with disabilities. It has helped individuals Bay area and Southern California move from nursing homes to their personal homes and offers a number of services to create their new lives easier, from kitchen supplies to wheelchair ramps.

“By taking a more integrated method of address people’s social and health needs, we view up to and including 30 percent savings in health care costs compared to the costs of the identical individuals before they joined our program,” said Dustin Harper, the institute’s v . p . for strategic partnerships. The company serves 20,000 Californians a year, including former nursing home residents, who be eligible for a Medicare or Medicaid, the federal-state health insurance program for low-income people, or both.

In addition to next year’s changes in supplemental benefits, CMS also noted that a new federal law allows Medicare Advantage intends to offer benefits that are not primarily health-related for Medicare Advantage members with chronic illnesses. What the law states and also the agency’s changes are complementary, CMS officials said. They promised additional guidance in the approaching months to help plans differentiate forwards and backwards.