Starting this fall, your ride to the doctor’s office or your home-delivered meal might be covered by your Medicare Advantage plan. The same goes for that air conditioner you need to help deal with your chronic asthma or the grab bar you needed installed in your shower for safety. Indeed, the popular Medicare Advantage programs are getting something of a make-0ver, and the result could make these policies even more attractive to seniors as a feature-laden alternative to traditional Medicare.
We were intrigued by this concept of adding features to Medicare Advantage plans when we read this article published very recently on the Kaiser Health News website. “Medicare Advantage Plans Cleared To Go Beyond Medical Coverage,” says the title – “Even Groceries”! Because of a new set of guidelines just approved by the Center for Medicare and Medicaid Services (CMS), the definition of benefits that are “primarily health-related” has been significantly expanded, giving the private firms that offer Medicare Advantage plans the latitude to sweeten the pot of features they offer their policy holders. The new rules take effect in 2019, so shoppers will start seeing the enhanced features during Medicare open enrollment this fall.
According to the Kaiser article, there are about 61 million Medicare enrollees, of whom one-third are covered by Medicare Advantage plans offered by private insurance companies. These plans typically offer wider coverage and more features at lower out of pocket cost than traditional Medicare, but the downside is greater restriction in the number of participating physicians and specialists. As Kaiser explains, “Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment.” The CMS guidelines will now allow insurers to “provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care.” Exactly what services and products this might include has not yet been fully decided.
“Although insurers are still in the early stages of designing their 2019 policies,” the Kaiser article says, “some companies have ideas about what they might include. In addition to transportation to doctors’ offices or better food options, some health insurance experts said additional benefits could include simple modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating and other personal care needs.” These services could make a significant difference in the number of seniors able to age in place, experts believe. The goal is not only to make these policies more attractive to consumers but also to help prevent avoidable injury and to keep chronic conditions from getting worse. According to one health care CEO, “CMS is catching up with the rest of the world in terms of its understanding of how we keep people healthy and well and living longer and independently.” She added, “Those are all positive steps.”
Some of these new services may sound frivolous, but this prevention-focused approach has actually been shown to be a cost-saver. One California non-profit called the Institute on Aging offers health, social, and psychological services for seniors and adults with disabilities. “By taking a more integrated approach to address people’s social and health needs,” reports one Institute on Aging exec, “we have seen up to a 30 percent savings in health care costs compared to the costs of the same individuals before they joined our program.” The agency serves 20,000 Californians a year who qualify for Medicare or Medicaid, or both.
It will be interesting to see how long this laundry-list of new benefits turns out to be. Also, we can’t help asking ourselves when traditional Medicare is going to get with the program, so to speak, and offer a competitive set of prevention-oriented services. Money spent on preventing medical problems and promoting healthier living has been demonstrated to be a sound investment. Make sure, if you’re a senior or if you’re caring for one, that you have a medical specialist on your team who practices preventive care and who understands the particular medical needs of older adults. A board-certified geriatrician should be your top choice. We have a list of geriatric physicians and can provide you with a referral if you’ll contact our AgingOptions office. We’ll also watch for new developments in the story of expanded Medicare Advantage benefits, coming this fall to an insurance policy near you.
There’s so much confusion and misinformation out there about health insurance! This article made us realize once again how important it is for seniors to get solid, professional and objective advice about every aspect of growing older. That certainly applies in the area of overall retirement planning. Instead of relying on a so-called investment advisor or insurance consultant who has a product to sell, we encourage you to seek the advice of an experienced professional like Rajiv Nagaich from AgingOptions. Rajiv will show you how all the pieces of your retirement plan need to fit together, just like the pieces of a puzzle: financial, legal, medical, housing and family. The result is a seamless plan called a LifePlan, a blueprint that will guide you as you create the fruitful and secure retirement of your dreams.
Why not invest just a few hours and find out more? Join Rajiv Nagaich at an upcoming LifePlanning Seminar – a free session packed with valuable information to show you what a wonderful experience retirement can be. For dates, times and locations, click here – then register online or call us during the week. We’ll look forward to meeting you and answering your retirement questions.
(originally reported at www.khn.org)
