Part of the aging process is eventually needing more assistance around the house or experiencing more difficulty in doing daily activities. Help is available through a service called personal home care assistance. But as people began to research this service for themselves or loved ones, they realized that more often than not, it wasn’t covered by insurance – until now.

Health insurers will soon be able to include non-medical benefits in Medicare Advantage (MA) plans – things like transportation to doctor visits, healthy foods and even home modifications like grab bars in the bathroom or air conditioners for people with asthma.

Expanded Help for Seniors to Begin in 2019 through Medicare Advantage Plans 600

In April 2018, the Centers for Medicare & Medicaid Services 1(CMS) expanded how it defines the “primary health-related” benefits in Medicare Advantage policies. Details are still in the works, but in 2019 insurers would include these extra benefits along with the regular benefits offered by traditional Medicare.

The aim of the new policy is to enable insurers to provide for care and devices that prevent or treat illnesses or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce the need for emergency medical care.

“Medicare Advantage beneficiaries will have more supplemental benefits, making it easier for them to lead healthier, more independent lives,” said CMS Administrator Seema Verma, announcing the proposed new federal rules.

Many Medicare Advantage plans already offer some health benefits – such as eyeglasses, hearing aids, and dental care – not covered by traditional Medicare. The new rules will expand that significantly to include items and services that aren’t necessarily considered medical treatment. Some of the services and items currently under review for potential coverage under the new proposed rules for Medicare Advantage include:

  • Adult day care services provided outside of the home, such as assistance with activities of daily living, rehabilitation activities or health-related social work services;
  • Home-based palliative care services to aid terminally ill members – not covered by Medicare – with a life expectancy of greater than six months;
  • In-home support services by state-licensed individuals to assist those with disabilities or medical conditions in performing activities of daily living;
  • Respite support for caregivers of MA enrollees in which a personal care attendant (or short-term institution-based care) supports the caregiver’s efforts by providing short-term assistance to the enrollee or providing counseling and training to the caregiver;
  • Medically approved non-opioid pain management to include therapeutic massage and other pain treatment alternatives;
  • A standalone memory fitness benefit;
  • Home and bathroom safety devices and modifications to prevent injuries and readmissions;
  • Health-related transportation, such as physician office visits; and
  • Over-the-counter health-related items and medications not covered by Medicare (e.g., pill cutters, pill bottle openers and personal electronic activity trackers).

These services or items must be deemed “medically appropriate” and recommended by a licensed healthcare provider, according to the suggested new rules. However, a physician’s order or prescription will not be necessary to access these new benefits.

The details of the proposed 2019 Medicare Advantage benefits must first be approved by CMS. They will likely be released in the fall of 2018, when the annual open enrollment period begins.

Of the 61 million people enrolled in Medicare in 2017, approximately 20 million have opted for Medicare Advantage, the privately-run alternative to the traditional government program. Medicare Advantage plans limit members to a network of providers, and similar restrictions may apply to the new proposed benefits.

Watch this article for updates about the 2019 Medicare Advantage benefits. If you have questions about your current insurance or Medicare Advantage plan, contact your insurer or call 1.866.KINDRED (1.866.546.3733) to speak with a Registered Nurse about what Kindred services are covered in your area. We are here 24 hours a day, seven days a week to walk you through care options.

By Mike Ogburn