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Medicare Advantage Plans May Expand Benefits

Proposal would allow some plans to pay for products that prevent falls, assist physically impaired

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About one-third of all Medicare beneficiaries are enrolled in Medicare Advantage plans.
Jose Luis Pelaez Inc/Blend Images/Gallery Stock

Next year the federal government plans to allow Medicare Advantage plans to cover items and services such as portable wheelchair ramps and “other assistive devices and modifications” that help people who have suffered falls, injuries or have other physical impairments.

“We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage (MA) plans to offer new health-related benefits,” Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), said in her announcement of the new policy.

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The goal in allowing these new benefits is to diminish the impact of injuries or health conditions as well as prevent falls and other incidents that require trips to the emergency room. Although Medicare pays for wheelchairs, walkers and canes, it does not currently cover things like grips or portable chairs in a shower or modifications to homes, such as widening a door for wheelchair access.

MA plans are currently allowed to offer supplemental benefits not covered by traditional Medicare, such as dental, vision and hearing. Traditional Medicare does not cover such additional services and that has some Medicare advocates concerned about this policy change.

“The initial impulse is this is great and these things should be covered,’’ says David Lipschutz, senior policy attorney at the Center for Medicare Advocacy. “But we would hope these things would be available to all Medicare beneficiaries. This continues to tip the scale in favor of Medicare Advantage over traditional Medicare.”

About one-third of all Medicare beneficiaries are enrolled in Medicare Advantage plans. According to CMS, the number of MA plans available across the country increased from about 2,700 in 2017 to more than 3,100 for 2018.

CMS noted that MA plans could not use the new benefits “solely to induce enrollment.” In addition, the services must be ordered by a licensed provider and focus directly on an enrollee’s health care needs.

But Lipschutz questions how federal officials would police these rules. “We want people who need these things to get them,” Lipschutz says. “But who is getting it and not getting it is part of the story.”

Public comments on the proposal will be accepted until March 5. CMS plans to announce the final rule on April 2. 

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