For some seniors, private Medicare Advantage plans next year will offer you a host of new benefits, such as transportation to medical appointments, home-delivered meals, wheelchair ramps, bathroom grab bars or air conditioners for asthma sufferers.
But the brand new benefits won't be accessible, and they won't be simple to find.
Of the 3,700 plans across the nation the coming year, only 273 in 21 states will offer you a minumum of one. About 7 percent of Advantage members – 1.5 million people – will have access, Medicare officials estimate.
That means for the savviest shoppers it will likely be a challenge to determine which plans offer the new benefits and who qualifies for them.
Medicare officials have touted the expansion as historic and an innovative method to keep seniors healthy and independent. Despite that enthusiasm, a full listing of the brand new services isn't on the web-based “Medicare Plan Finder,” the federal government tool used by beneficiaries, counselors and insurance agents to evaluate a large number of plan options.
Even if people subscribe to those plans, they won't be entitled to all of the benefits. Advantage members will need a recommendation from a doctor within the plan's network. Then they may need to have a certain chronic health condition, a recent hospitalization or meet other eligibility requirements.
Medicare counselors from California to Maine say key details are not included on the government’s website. In some instances, if insurers offer the new benefits, the plan finder “will indicate ‘yes’ or ‘no,'” said Georgia Gerdes any adverse health care choices specialist at AgeOptions, the region Agency on Aging in Oak Park, Ill., outside Chicago. That’s hardly enough, she said.
“There is lots of information on the plan finder, but there is a lot of information missing that needs beneficiaries to complete more research,” said Deb McFarland, Medicare services program supervisor at the Southern Maine Agency on Aging.
Nonetheless, officials the advantages can help Advantage members prevent costly hospitalizations. Federal approval of additional benefits is “one of the most significant changes made to the Medicare program,” Seema Verma, the head from the Centers for Medicare & Medicaid Services, told an insurers' meeting recently. She said she expects plans to expand services in coming years.
Medicare Advantage plans, which are an alternative choice to traditional Medicare, serve 21 million beneficiaries and limit their out-of-pocket expenses. But they also restrict members to some network of doctors, hospitals and other medical providers. They often offer benefits unavailable in traditional Medicare, such as dental and vision care, hearing aids and gym memberships.
The federal government pays a set amount towards the intends to help cover the price of each member. The Trump administration gave insurers more money to spend on benefits the coming year – an average pay raise of 3.4 percent, seven times a lot more than the rate of increase in 2021.
Enrollment is underway for Medicare Advantage plans, as well as for people in traditional Medicare who wish to buy a insurance policy for drug coverage. The deadline for selecting either kind of plan is Dec. 7.
Among the brand new benefits that some Medicare Advantage plans said they will offer are:
- Trips to the pharmacy or fitness center along with doctor’s appointments for plan members, depending on their current address or their health conditions.
- A monthly or quarterly allowance for over-the-counter pharmacy products such as cold and allergy medications, eye drops, vitamins, supplements and compression stockings.
- House calls by doctors or any other health care providers, under certain conditions.
- A home health care aide for any limited number of hours to assist with dressing, eating along with other daily activities, possibly including household chores and light housekeeping.
However, plans offering these along with other services will likely have only a few of the options and will have different eligibility criteria along with other limitations. The same services likely won’t be available in every county the plan serves.
For example, the coming year an estimated 150,000 Humana Medicare Advantage members in Texas and Florida – two of the 43 states Humana serves – who cannot be left alone in your own home can get a free in-home personal care aide for up to 42 hours a year, to ensure that their regular caregiver can get a break. And more than 1 / 2 of the members in Cigna-HealthSpring Advantage plans will have use of free transportation services in all but five from the 16 states and also the District of Columbia in which the company sells coverage.
To find these supplemental benefits, seniors may use the internet plan finder. After they enter their Zipcode and get a list of plans available locally, they are able to click an agenda name. That will take them to a different page that offers additional information about coverage, together with a tab for health and drug plan benefits. That page might say if the new releases can be found.
But usually the website only will indicate that exact benefits can be found – and perhaps not name them – and advise consumers to contact the program for more information. A Medicare spokesperson confirmed that there's currently no indicator on the plan finder for plans offering these expanded health-related supplemental benefits.
In accessory for extra benefits, other variables should be considered when selecting an Advantage plan, such as which medical service providers and pharmacies take part in a plan’s network, which drugs are covered and the costs.
Where available, several insurers the new services is going to be free with no increase in monthly premiums.
“We certainly believe that all of the ancillary benefits we offer can help keep our members healthy, that is good for them, and it’s good for us in the long run,” said Steve Warner, head of the Medicare Advantage product team at UnitedHealthcare, which insures about 5 million seniors or 1 in 4 Medicare Advantage members.
Insurers are betting that services will ultimately pay for themselves.
Dawn Maroney, consumer president at Alignment Healthcare, which serves eight counties in Southern California, said it’s less expensive to give an aura conditioner to someone with congestive heart failure to help keep that patient healthy than to purchase more costly medical treatment.
But if the new benefits are such a wise decision, they should be available to the majority of older adults in traditional Medicare, said David Lipschutz, a senior policy attorney at the Center for Medicare Advocacy.