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Supplemental Home Health Benefits Now Permitted in Medicare Advantage Plans

By Danielle Roberts

Starting in 2019, the Centers for Medicare and Medicaid Services (CMS) granted Medicare Advantage plans more flexibility to cover additional services that help seniors stay out of the hospital and safely age at home. The Bipartisan Budget Act of 2018 authorized several new changes and supplemental benefits for Medicare Advantage plans.

Because Medicare Advantage plans are offered by private insurance companies, they have traditionally offered extra benefits not available with Original Medicare. For example, many Medicare Advantage plans cover routine vision and dental care, which isn’t covered under Part A and Part B. Some of them also have things like hearing aid benefits and even gym memberships.

Prior to the new budget act, Medicare Advantage plans were very limited in the type of over-the-counter products and home care services they could cover. This is because Medicare itself doesn’t usually cover services that fall into the realm of custodial care or long-term care.

Now, however, there is more leeway for plans to offer additional benefits to plan members and their caregivers. Most of these new benefits will not be extended to Original Medicare and/or Medigap plans. They will only be permitted in Medicare Advantage plans for the time being.

An independent research firm surveyed Medicare Advantage plans and discovered that nearly 50% will be adding one or more of the new supplemental benefits in 2019, with nearly 70% upping their supplemental benefit offerings in 2020. This is welcome news for any Medicare beneficiary that has maybe been considering switching from Original Medicare over to a Medicare Advantage plan but hasn’t yet made the leap.

Here’s a look at some of the different types of supplemental benefits you may be able to get with Medicare Advantage this year.

Nicotine Replacement Therapy

If you use a nicotine patch or nicotine gum or other type of nicotine replacement product, your Medicare Advantage plan may now pay for it. About half of all plans indicated they would offer this benefit in 2019. This benefit was likely approved because Medicare is beginning to recognize that prevention of lung cancer will save Medicare many millions of dollars. Helping smokers to kick the habit is a long-term play.

Over-the-Counter Benefits

Coverage of over-the-counter items has expanded to include things like pill cutters and pill crushers, personal activity trackers, and digital thermometers. Some plans provide a monthly allowance for covered OTC items already, but with the new allowances, we expect to see more carriers begin to incorporate these benefits.

Plans may choose which additional OTC items they will cover in each of their plan designs. The benefit is not standardized for all Medicare Advantage plans.

Caregiver Support

Medicare Advantage plans may now cover adult daycare, respite care, and counseling and training sessions for people caring for a Medicare Advantage plan member. The benefit may be limited to a certain number of hours or capped at a certain dollar amount for the plan year.

Prior to this, respite care has been largely limited only to hospice benefits, which means that caregivers, especially family caregivers, have rarely had a break. These caregiver support services will offer a welcome relief from the burden of caring for a chronically ill Medicare beneficiary.

In-Home Support Services

In the past, coverage for home health services was limited to medical therapies and skilled nursing care. Custodial home care services would only be approved if the beneficiary was also under skilled nursing care.

Now, some Medicare Advantage plans will cover housekeeping services, meal delivery, and even aides to help with activities of daily living such as bathing, dressing, and eating. The benefit is generally limited to a certain number of hours of care each year. This benefit was specifically designed to help chronically ill beneficiaries remain living independently in their own homes for as long as possible.

Transportation

Some Medicare Advantage plans are covering the cost of transportation to and from medical and wellness visits, pharmacies, and other necessary services for qualifying plan members. The benefit might cover the cost of a fixed number of one-way trips per year using a taxi or other service like Uber or Lyft.

Prior to this, we rarely saw transportation benefits included in Medicare Advantage plans unless the plan was specifically designed for beneficiaries who were dually eligible for both Medicare and Medicaid. However, there are many seniors out there who don’t qualify for Medicaid but could certainly benefit from help with transportation. Again, the goal is to help people continue to live in their own homes for a longer period of time before needing an assisted living or long-term care facility.

Home Safety Devices

Your Medicare Advantage plan may offer an annual allowance for purchasing or installing home safety devices such as bathroom handrails, wheelchair ramps, and reaching devices. This benefit will help to prevent unnecessary falls and trips to the emergency room which can rack up a great deal of Medicare spending.

Other Medicare Advantage Supplemental Benefits

In some cases, you may need a referral from your doctor to use the supplemental benefits, and you may need to use certain providers approved by your Medicare Advantage plan.

You should be aware that these benefits are typically not unlimited. Plans may set a monthly or yearly limit on the amount they will pay in the different benefit categories. If you are considering enrolling into a Medicare Advantage plan to gain access to some of these new benefits, be sure that you carefully review the plan’s Summary of Benefits so that you’ll know how much of each benefit you can expect from the plan once you enroll.

Also, these benefits will be incorporated into your standard Medicare Advantage plan benefits. You won’t be charged a separate premium for these supplemental benefits as you might for other supplemental vision or dental benefits. These benefits are available at no extra cost to plan members.

If your Medicare Advantage plan doesn’t offer many supplemental benefits in 2019, it may in 2020. The new rule was finalized at a time when most Medicare Advantage plans had already determined their plan benefits for 2019. Expect to see more plans offering additional benefits for the 2020 plan year.

For more information on affording long-term care, download our eBook: The Complete Roadmap to Long-Term Care.

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Tags: Medicare

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