It is now official that in January 2019, Medicare Advantage (MA) is going to offer even more “advantages”. On May 9, 2018 the Centers for Medicare and Medicaid Services (CMS) finalized rules allowing Medicare Advantage plans to provide supplemental healthcare benefits. These new benefits include an item or service, which was not covered by Medicare originally, but is “primarily health related” and MA incurs a direct medical cost from it. The new rule also allows Medicare Advantage Organizations (MAOs) more flexibility to target supplemental benefits, especially those related to the chronically ill.
Currently, there are 61 million people enrolled in Medicare, with 20 million of them opting for Medicare Advantage, the privately run alternative to the traditional government program. Below are examples of the new “primarily health-related” benefits that these 20 million beneficiaries may have covered starting in January 2019:
- Air conditioners for beneficiaries with asthma
- Healthy foods
- Rides to medical appointments
- Home delivered meals
- Low cost hearing aids
- Mobile dental clinics
- Grocery stores on wheels
- Simple modifications to beneficiaries’ homes, such as grab bars in bathrooms
- Aides to help with daily activities, including dressing, eating and other personal care needs
These items will not require an order from a physician or a prescription, but they must be considered “medically appropriate” and recommended by a licensed provider.
Making an Informed Decision
The final benefits plans offered by each MAO will be approved by CMS first. These approved, new plans will be available at the time of annual open enrollment in the fall of 2018. Even though these plans may seem very enticing, it really behooves a beneficiary to take a good, hard look at the benefits being offered in the different plans and consider the following questions:
- How many of these new services and/or items do I currently use?
- What are my current costs associated with them?
- Do I foresee a change in my usage?
- Will my licensed provider recommend some of these new benefits for me?
- What is the difference in premium between Medicare Advantage and traditional Medicare?
- Would it make more financial sense if I purchased some of these items myself and just kept my traditional Medicare plan and maybe even a supplement too?
Be sure to read the fine print before making a decision regarding your Medicare coverage. Plans across the country vary tremendously; therefore, it is unlikely that all the new, proposed benefits will be available to all beneficiaries. Time will only tell what the real advantages will be!
The 5 Star Advantage
Our knowledgeable team can help to keep your staff up to date on the constant changes in the home health and hospice industries. We offer onsite training, webinars and manuals about the latest laws and regulations required by Medicare and other regulatory bodies. The information we provide is very comprehensive yet organized and offered in an easy to understand manner. If you are interested in learning more about our educational options, please feel free to contact us at [email protected] or 866-428-4040.