En español | If you’re enrolled in a Medicare Advantage plan or thinking about joining one, you may be entitled to some new services, especially if you’re one of the 73 percent of MA members who have chronic health conditions.
Beginning in 2020, Medicare Advantage (MA) plans will have the option of covering things that you don’t usually think about when it comes to health insurance. For example, someone with diabetes could get transportation to a doctor’s appointment, to a diabetes education program or to a meeting with a nutritionist. MA plans can even pay for cooking classes as part of improving someone’s diet. For someone with heart disease, an MA plan could provide heart-healthy produce or other food. If you have asthma, the plan could cover home air cleaners or even pay to shampoo a member’s carpet to remove the irritants that often trigger asthma attacks.
“If someone has asthma,” says Seema Verma, administrator of Medicare and Medicaid, “if they just shampoo the carpet that might make the difference and keep them out of the hospital.” The expansion of these nontraditional services is a recognition “that health outcomes are tied to a lot of different factors in a person’s life.”
Also beginning in 2020, MA plans may pay for improvements to a member’s home, such as permanent ramps or wider hallways and doors to accommodate wheelchairs. This is the second year in a row that the Centers for Medicare and Medicare Services (CMS) has broadened the services an MA plan can cover. As of Jan. 1, Medicare started allowing these plans to pay for shower grips and other safety devices designed to prevent falls.
“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 says.
During the annual open enrollment period approaching (from Oct. 15 through Dec. 7), millions of Medicare beneficiaries will decide whether to stay in their current MA plan or switch from original Medicare to the private insurance alternatives. And MA members can also decide to enroll in original Medicare.
The main difference between original Medicare and an MA plan is the ability to choose physicians and other providers. Under original Medicare, beneficiaries can go to any provider who accepts Medicare — and the vast majority of doctors do. MA plans have networks of doctors and hospitals, and if you go to someone outside the network you generally have to pay much more. MA policies are one-stop shopping plans and usually include prescription drug coverage, and some pay for dental, hearing and vision — as well as have the option to offer the supplemental services.
The trend toward MA plans has been steadily increasing over the past several years. In 2019, one-third of Medicare beneficiaries — 22 million people — enrolled in MA plans, and the nonpartisan Congressional Budget Office estimates that by 2029, 47 percent of Medicare patients will be in MA plans.
Not all Medicare Advantage plans offer the extra benefits CMS allows. This year, about 21 percent of MA enrollees are in plans that offer extra benefits, according to a study by the Journal of the American Medical Association. Most of the plans offered services that supported caregivers or other in-home support.
Asked why beneficiaries who have original Medicare also cannot get those services, Verma said Congress gave her agency the authority only to expand these benefits to MA enrollees.
Editor’s note: This article has been updated to reflect 2020 benefit information.