Blog - Waiver – Medicare Advantage Expands

Waiver – Medicare Advantage Expands

Waiver – Medicare Advantage Expands

Recently, the Centers for Medicare & Medicaid Services (CMS) announced a plan to expand products and services covered by Medicare Advantage plans.
The department has revised its definition of “primarily health-related” benefits to help Medicare Advantage enrollees lead more independent lives. Some of the new services could include minor home modifications such as grab bars, transportation to and from medical appointments, and home-delivered meals.
A prescription is not needed for the new covered services, but they must be “medically appropriate” and recommended by a healthcare provider. Coverage will vary depending on the plan.
A total of 11.8 million Americans signed up for ACA health insurance for 2018, a drop of just 400,000 from the previous year despite widespread predictions that enrollment would plummet amid political and insurance industry turbulence surrounding the law.

The final figures, released Tuesday by the Centers for Medicare and Medicaid Services, show:

– The proportion of first-time customers for this year dipped slightly, from 31 percent to 27 percent
– While the high proportion qualifying for government subsidies that help consumers afford their insurance premiums stayed level at 83 percent.
– The enrollment total in the new federal report is identical to that from a compilation published by the National Academy for State Health Policy.

The CMS expanded how it defines the “primarily health-related” benefits that may include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers. Medicare Advantage beneficiaries will have more supplemental benefits making it easier for them to lead healthier, more independent lives.

Here is Why:

– Of the 61 million people enrolled in Medicare last year, 20 million have opted for Medicare Advantage, a privately-run alternative to the traditional government program. Advantage plans limit members to a network of providers. Similar restrictions may apply to the new benefits.

– Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment.

– CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care.

Although insurers are still in the early stages of designing their 2019 policies, some companies have ideas about what they might include. Some of these include better food options, simple modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating and other personal care needs.

The new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules.

CMS has cautioned that new supplemental benefits should not be items provided as an inducement to enroll. All parties feel that Medicare benefits should not be one-size-fits-all, and continued rate stability and greater benefit design flexibility enable health plans to provide a more personalized health care experience.

What’s Next?

The details of the 2019 Medicare Advantage benefit packages must first be approved by CMS and will be released in the fall, when the annual open enrollment begins. It’s very likely that all new benefits will not be available to all beneficiaries since there is “tremendous variation across the country” in what plans offer.
In addition to next year’s changes in supplemental benefits, CMS notes that a new federal law allows Medicare Advantage plans to offer benefits that are not primarily health-related for Medicare Advantage members with chronic illnesses. The law and the agency’s changes are complementary, CMS officials said. They promised additional guidance in the coming months to help plans differentiate between the two.

Source: Healthcare Reform News Update – April 4, 2018

Photo by Freepik