CVC Case Manager Tomi Vega is a certified application counselor under the Affordable Care Act as determined by the Centers for Medicare and Medicaid Services.
Medicare Advantage—the private plan add-on option in the Medicare program also know as Part C—has new flexibility to cover expenses such as transportation or caregiver support. The extra benefits are fairly limited for 2019, but that’s expected to change in 2020.
Until March 31, anyone already enrolled in an Advantage plan for 2019 can make certain changes to their coverage. You can cancel your plan, switch to a different Advantage plan or sign up for a Part D drug plan. (Look for a blog with more about your options during this window soon.)
Whether or not you’re making changes this year, you may want to take a moment to learn more about what new benefits are coming, and what changes you could see this year and next.
What are the new benefits?
For years, Advantage plans offered a small, fixed list of supplemental benefits like vision, hearing and dental care. But the Centers for Medicare and Medicaid Services (CMS) relaxed that list in late 2018, allowing Advantage plans beginning in 2019 to offer coverage for any goods and services as long as they reduce avoidable emergency department visits, or are used to diagnose, prevent, or treat injuries or health conditions.
Advantage plans have used the expanded definition of items eligible for coverage to offer new benefits to their members. The new benefits (also known as wellness programs) seen so far are:
- Nicotine replacement therapy.
- Caregiver support services like respite care, counseling, and training.
- In-home support and personal care services like assistance with housekeeping tasks, bathing, eating and dressing.
- Expanded coverage of over-the-counter products like non-prescription medications, compression stockings, and pill bottle openers.
- Social worker phone line.
- In-home palliative care.
- Massage therapy.
- Transportation to places like the pharmacy or a fitness center.
- Adult foster care.
What can I expect in 2019?
About 270 of the 600 plans for 2019 included at least one of the new benefits, according to CMS.
CMS announced the rule change just a few months before insurers submitted their final plan designs. As a result, insurance companies had limited time to rearrange plans to include new benefits.
For those that did add benefits right away, the most common are:
- Nicotine replacement therapy.
- Caregiver support services.
- In-home support.
Many think the addition of these supplemental benefits is a step toward offering more complete health services. Nevertheless, if you have Medicare, you should be aware that benefits might not be available to everyone. Insurance companies have the option to offer only certain wellness programs and also only make them available to individuals with certain health conditions.
Additionally, greater differences in available benefits between Advantage plans may turn the already daunting task of comparing Advantage plans and choosing the best coverage option into an even bigger job.
The plan finder tool on Medicare’s website does not yet provide information about supplemental benefits offered by Advantage plans under this new rule. Individuals looking for these specific supplemental benefits should check with each Advantage plan directly to find out what they offer and if there are any restrictions, such as having a certain health condition.
CMS expects many more insurers to add extra new benefits in 2020.
Even more changes in 2020
In addition to the extra plans expected, in 2020, under the Bipartisan Budget Act of 2018, Advantage plans will be allowed to offer supplemental benefits to chronically ill enrollees that are not primarily health related. These expanded benefit options must only “have a reasonable expectation of improving or maintaining the health or function of the beneficiary.” This means Advantage plans will be able to provide coverage for additional services such as:
- Transportation for non-medical needs.
- Home-delivered meals.
- Home modifications like installation of grab bars in the bathroom, wheelchair ramps, and air conditioners.
With more flexibility and more time to update their plan designs to include new supplemental benefits, CMS expects that a larger number of insurers will offer more benefits beginning in 2020. Currently, it’s difficult to find information about the availability of these benefits, since Medicare’s plan finder tool doesn’t include them. However, it is still early in the year and the landscape could change for 2020 plan enrollment.