En español | For the second year in a row, Medicare Advantage (MA) plans will be able to increase their benefits, including expanded home meal deliveries, transportation and even some housecleaning, the administrator of the Centers for Medicare and Medicaid Services (CMS) announced late Monday.
Under the new policies, MA plans in 2020 can cover a broad range of supplemental benefits that aren’t typically considered health needs but, CMS officials say, “have a reasonable expectation of improving or maintaining the health or overall function” of Medicare enrollees.
Last year, MA plans were given the authority to cover such items as shower grips, wheelchair ramps and other modifications to the homes of beneficiaries who needed them because they had fallen or had other mobility issues. Those added benefits had to be medically related.
But this latest expansion of benefits, CMS Administrator Seema Verma said in a phone call Monday, can go beyond medical services to particularly help beneficiaries with chronic diseases and give health plans the ability to innovate. For example, if someone has asthma, getting their carpet cleaned might keep them out of the hospital, Verma said.
“It really is a significant change to the program in the sense that this is the first time we’ve allowed these private health plans to have this level of flexibility” and to tailor benefits to individual patient needs, Verma said.
Medicare Advantage plans are private insurance plans that Medicare beneficiaries can choose instead of the original Medicare. The main differences between MA and original Medicare are that MA plans typically have networks of doctors that enrollees must use and are one-stop shopping plans that cover hospital care, doctor visits, prescription drugs and often other services Medicare doesn’t typically cover, including dental, vision and hearing. Under original Medicare, beneficiaries have an unrestricted choice of doctors and hospitals that accept Medicare. Original Medicare beneficiaries can buy separate plans for prescription drugs (Part D) and supplemental policies to cover some deductibles and copays.
Asked why beneficiaries who have original Medicare cannot also get these supplemental services, Verma said Congress only gave her agency the authority to expand these benefits to MA enrollees. She did say there might be some pilot programs in the future in which some providers under original Medicare would offer such benefits. Enrollment in MA plans has been steadily increasing, and Verma said she expects that this benefit expansion will also lead to more Medicare beneficiaries choosing MA plans.
Beneficiaries will be able to sign up for plans that offer these new benefits during this fall’s open enrollment, and CMS is enhancing its plan-finder tool, Verma said, so enrollees will be able to see which MA plans are offering any of the new services. It’s too early to know whether MA plans that offer these extra services will charge higher premiums. MA plan rates typically are not announced until the fall.