Medicare Advantage enrollees can expect new benefits with the start of 2019. “CMS’ decision to expand the definition of health-related benefits is part of a much broader transformation within the healthcare industry to treat health holistically,” says Christopher Ciano, head of Aetna Medicare, a health insurer in Hartford, Connecticut. “Increasingly, providers, members, and payers alike are realizing that being ‘healthy’ is about more than physical health. Rather, it’s about addressing social determinants of health, including access to healthy food, transportation, and social support that can negatively impact health outcomes.”
Here’s a look at three things health executives should know about changes to Medicare Advantage plans.
1. New items and services will be covered. As of 2018, CMS didn’t allow an item or service to be eligible as a supplemental benefit if the primary purpose was daily maintenance. Starting on January 1, 2019, Medicare Advantage plans will offer supplemental benefits to diagnose, prevent, or treat illnesses or injuries or mitigate the impact of health conditions. “This is an expansion beyond the benefits that were typically related to dental, hearing, and vision benefits,” says Ashraf Shehata, MPA, MBA, principal at KPMG, an audit, tax, and advisory firm. “The expansion of these benefits sometimes veers into addressing some of the social determinants that drive healthcare costs, such as adult day care. The main objective is to use these programs to avert hospitalizations that can drive up overall healthcare spending.”
Supplemental benefits have also expanded to include safety devices in the home, transportation, and home-based palliative care. Medicare Advantage programs will now be allowed to offer the Medicare Diabetes Prevention Program, which offers classes aimed at promoting healthy lifestyles for pre-diabetic Medicare beneficiaries, Shehata says. The programs have no out-of-pocket cost and don’t need a referral.
Another significant change for 2019 is being referred to as the “Plan Test Drive.” This new regulation allows patients to try out a Medicare Advantage plan for up to three months. If an enrollee isn’t satisfied with the plan they’ve enrolled in, they can switch to another Medicare Advantage plan or to original Medicare. “This offers greater flexibility in determining which plan works best for a patient’s personal health situation,” says Amar Desai, MD, MPH, president, Healthcare Partners California, a division of DaVita Medical Group, which operates and manages medical groups and affiliated physician networks.
2. More time may be needed to implement changes. Most insurance carriers offering Medicare Advantage plans were not able to get all of these new benefits implemented for 2019 because CMS’ April 2018 announcement didn’t allow them enough time.
However, Chris Hakim, general manager of eHealthMedicare.com, a Medicare insurance marketplace located in Mountain View, California, notes that in recent years it’s been a race for Medicare Advantage plans to include more benefits and maintain or even slightly reduce premiums. “With a shift toward value-based care, new services can help beneficiaries better manage their own health, and for health plans, added benefits can be a differentiator they can market to Medicare-eligible individuals,” he says.
While new benefits, such as adult day care and in-home support services won’t be widely available in Medicare Advantage plans for 2019, some additional services that have been included in these plans will be offered by more plans than in years past. For example, of the more than 2,500 plans on eHealthMedicare.com, 37% will offer routine transportation, such as an Uber or Lyft ride to a doctor’s office, in 2019. This is up from 27% of plans in 2018, Hakim says. In addition, for 2019, 50% of plans cover meals for a set number of days when a patient arrives home from the hospital. This is an increase from the 31% of plans that covered this in 2018.
3. Commercial payers won’t follow suit. Richard L. Trembowicz, JD, associate principal, ECG Management Consultants, a healthcare consulting firm, doesn’t expect payers who offer commercial products to employers and individuals to make similar changes to their offerings. “Most of the new benefits offered by Medicare Advantage plans are very specific to the Medicare population,” he says. “These benefits are not commonly in demand in commercially insured populations. Most of these benefits are being designed by Medicare Advantage plans as alternatives to more expensive intuitional care and services, so there is often a return on investment, but it is dependent on the demographic and clinical characteristics of the covered population.”
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.